冠状动脉斑块旋磨术联合药物洗脱支架置入术治疗冠状动脉严重钙化病变的安全性和有效性

摘要

Objective To investigate the safety and efficacy of rotational atherectomy followed by drug-eluting stent implantation for treating patients with heavily calcified coronary lesions.Methods From March 1,2010 to September 1,2012,65 cases with 78 heavily calcified coronary lesions which were treated with rotational atherectomy followed by drug-eluting stent implantation in Peking University People's Hospital were included,and 36 cases also underwent intravascular ultrasound to guide the rotational atherectomy procedure and drug-eluting stent implantation.All patients were followed up in hospital and post discharge.Procedure parameters,complications and major adverse cardiovascular events (cardiac death,non-fatal myocardial infarction,percutaneous coronary intervention related myocardial infarction,target vessel revascularization,recurrent angina,intra-stent restenosis and stent thrombosis) were analyzed.Results Direct rotational atherectomy was performed in 64.6％ (42/65) patients,rescued rotational atherectomy in 35.4％ (23/65) patients,drug-eluting stents implantation was applied to all cases after rotational atherectomy.The immediate procedural success rate was 100％ (78/78).The average burr/artery ratio was 0.50 ±0.04,the average number of burr used per case was 1.15 ±0.36.The average burr/artery ratio was 0.52±0.03 and the average number of burr used per cases was 1.19 ±0.40 in 36 cases guided with intravascular ultrasound.Five cases (7.7％) developed complications and were treated accordingly during procedure with satisfactory results.The incidence of major adverse cardiovascular events was 13.8％ (9/65) during (17.6 ± 8.5) months follow-up.Conclusion Rotational atherectomy followed by drug-eluting stent implantation is a safe and efficient technique for treating heavily calcified coronary lesions.%目的 探讨冠状动脉斑块旋磨术联合药物洗脱支架置入术治疗冠状动脉严重钙化病变的安全性和有效性.方法 回顾性分析2010年3月1日至2012年9月1日在北京大学人民医院因冠心病行冠状动脉斑块旋磨术和药物洗脱支架置入术的全部病例.共入选65例冠心病患者78处病变(均为严重钙化病变),其中36例患者在术中行血管内超声检查,并指导冠状动脉斑块旋磨术和药物洗脱支架置入术.术后对所有病例进行住院期间和出院后随访.分析其手术特点、并发症及主要不良心血管事件(包括心原性死亡、非致死性心肌梗死、介入治疗相关心肌梗死、靶血管血运重建、心绞痛复发、支架内再狭窄和支架内血栓形成)的发生率.结果 64.6％ (42/65)患者行直接冠状动脉斑块旋磨术,35.4％ (23/65)患者行补救性冠状动脉斑块旋磨术,术后均置入药物洗脱支架.手术即刻成功率为100％(78/78).使用的旋磨头直径与血管直径比值为0.50±0.04,每例患者使用的旋磨头数量为(1.15 ±0.36)个.行血管内超声检查的36例患者使用的旋磨头直径与血管直径比值为0.52±0.03,每例患者使用的旋磨头数量为(1.19±0.40)个.术中共有5例(7.7％)患者发生并发症,处理后均获得良好效果.术后随访(17.6±8.5)个月,主要不良心血管事件的发生率为13.8％(9/65).结论 冠状动脉斑块旋磨术联合药物洗脱支架置入术治疗冠状动脉严重钙化病变安全、有效.