冠状动脉旋磨术在慢性完全闭塞病变介入治疗中的疗效The effective of coronary rotational atherectomy in chronic total occlusion intervention
李文铮,吴铮,柳景华,郑斌,吕昀,刘佟
摘要(Abstract)：
目的 比较冠状动脉旋磨术在慢性完全闭塞（CTO）病变和非CTO病变中的疗效。方法 入选2018年1月至2021年3月在首都医科大学附属北京安贞医院行冠状动脉旋磨术的患者，比较CTO组和非CTO组冠状动脉旋磨术的手术特点、术中并发症及住院期间主要不良心脑血管事件。结果 CTO组患者年龄小于非CTO组[（59±10）岁比（63±10）岁，P=0.045]，高脂血症患者比例更高（90.6%比71.4%,P=0.026）。CTO组参考血管直径显著小于非CTO组[（2.70±0.45）mm比（2.94±0.31）mm,P=0.001]，旋磨头直径与靶血管直径比更大[（0.50±0.06）%比（0.46±0.07）%,P=0.008]。CTO组旋磨初始转速和通过病变转速显著低于非CTO组[初始转速（16.14±0.86）×10~4r/min比（1 6.9 8±1.5 1）×10~4r/min,P=0.0 0 3；通过病变转速（17.08±1.45）×10~4 r/min比（17.84±1.79）×10~4 r/min,P=0.030]。冠状动脉旋磨术后靶血管残余狭窄程度CTO组更高[（68±11）%比（53±17）%,P<0.001]。两组患者冠状动脉旋磨术后即刻和介入治疗术后心肌梗死溶栓治疗试验（TIMI）血流分级Ⅲ级比例比较，差异均无统计学意义（均P>0.05）；术中并发症和住院期间不良心脑血管事件发生率比较，差异均无统计学意义（均P>0.05）。结论 CTO组冠状动脉旋磨术后即刻管腔获得更低，但冠状动脉旋磨术在CTO介入治疗中安全有效。
关键词(KeyWords)： 冠状动脉疾病;慢性完全闭塞病变;冠状动脉旋磨术
基金项目(Foundation): 国家自然科学基金项目（81970291）
作者(Author): 李文铮,吴铮,柳景华,郑斌,吕昀,刘佟
参考文献(References)：
- [1] Barbato E, CarriéD, Dardas P, et al. European expert consensus on rotational atherectomy[J]. EuroIntervention,2015,11(1):30-36.
- [2] Sharma SK, Tomey MI, Teirstein PS, et al. North American expert review of rotational atherectomy[J]. Circ Cardiovasc Interv,2019,12(5):e007448.
- [3] Hoff mann R, Mintz GS, Popma JJ, et al. Treatment of calcifi ed coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study[J]. Eur Heart J,1998,19(8):1224-1231.
- [4] Morino Y, Abe M, Morimoto T, et al. Predicting successful guidewire crossing through chronic total occlusion of native coronary lesions within30 minutes[J]. JACC Cardiovasc Interv,2011,4(2):213-221.
- [5] Adhikari BK, Wang S, Li C, et al. Various scoring systems for predicting revascularization of chronic coronary total occlusion by percutaneous coronary intervention[J]. World J Cardiovasc Dis,2019,9(6):385-393.
- [6] Whitlow PL, Bass TA, Kipperman RM, et al. Results of the study to determine rotablator and transluminal angioplasty strategy(STRATAS)[J]. Am J Cardiol,2001,87(6):699-705.
- [7] Reisman M, Shuman BJ, Dillard D, et al. Analysis of low-speed rotational atherectomy for the reduction of platelet aggregation[J].Cathet Cardiovasc Diagn,1998,45(2):208-214.
- [8] Williams MS, Coller BS, V??n?nen HJ, et al. Activation of platelets in platelet-rich plasma by rotablation is speed-dependent and can be inhibited by abciximab(c7E3 Fab; ReoPro)[J]. Circulation,1998,98(8):742-748.
- [9] Tomey MI, Kini AS, Sharma SK. Current status of rotational atherectomy[J]. JACC Cardiovasc Interv,2014,7(4):345-353.
- [10]王伟民，霍勇，葛均波.冠状动脉钙化病变诊治中国专家共识（2021版）[J].中国介入心脏病学杂志，2021,29(5):251-259.
- [11]滕玮利，曹成富，李琪，等.冠状动脉斑块旋磨术治疗严重钙化病变的临床结果及影响因素分析[J].中国介入心脏病学杂志，2021,29(11):601-606.
- [12] Azzalini L, Dautov R, Ojeda S, et al. Long-term outcomes of rotational atherectomy for the percutaneous treatment of chronic total occlusions[J]. Catheter Cardiovasc Interv,2017,89(5):820-828.