DES时代经桡动脉冠状动脉旋磨术治疗严重钙化病变的安全性、有效性及对分支血管的影响

摘要

目的探讨药物洗脱支架（DES）时代经桡动脉冠状动脉旋磨术治疗严重钙化病变的安全性、有效性及对分支血管的影响。方法回顾性分析2012年1月1日至2014年6月30日在本院行冠状动脉旋磨术的24例患者的冠状动脉病变特征、介入治疗情况、手术并发症、旋磨对病变处及远端分支血管的影响及出院后主要不良心血管事件的发生率。结果24例患者共26处冠状动脉严重钙化病变，均经桡动脉成功行冠状动脉旋磨术，旋磨后病变处狭窄程度由（89.5±7.3）%降至（37.6±5.6）%，差异具有显著性（P＝0.000）。所有病变均成功置入DES，术中、术后无并发症发生。26处钙化病变共20条分支血管，旋磨后所有分支血管均未发生栓塞、夹层，开口直径无显著变化。24例患者平均随访（11.0±6.1）个月，2例分别于术后4个月和15个月因重症肺炎死亡，其余患者在随访期间未发生主要不良心血管事件，6例术后复查冠状动脉造影，无支架内血栓形成、再狭窄及晚期支架贴壁不良。结论 DES时代经桡动脉冠状动脉旋磨术治疗严重钙化病变具有较好的安全性和有效性，且对病变处及远端分支血管无明显影响。%Objective To investigate the safety, efficacy and influence on branch vessels of rotational atherectomy via radial approach in patients with heavily calciifed coronary lesions in drug-eluting stents (DES) era. Method From January 1, 2012 to June, 30, 2014, 24 cases treated with rotational atherectorny in our hospital were included. Coronary lesions and procedure parameters, complications, branch vessels and major adverse cardiovascular events were analyzed. Result 24 cases with 26 heavily calcified coronary lesions were treated successfully with rotational atherectorny via radial approach and no complication was observed. The degree of stenosis went down signiifcantly from (89.5±7.3)%to (37.6±5.6)%. DES implantation was successfully applied to all cases after rotational atherectomy. A total of 20 distal branch vessels were analyzed after rotational atherectorny and no embolization, dissection or signiifcant vessel diameter change occurred. 2 patients died 4 and 15 months after rotational atherectorny because of severe pneumonia. The remaining patients survived well without major adverse cardiovascular events during (11.0±6.1) months follow-up. 6 patients received the coronary angiography follow-up and no in-stent restenosis, thrombosis and late stent malapposition was found. Conclusion In DES era, via radial approach rotational atherectorny is a safe and efifcient technique for treating heavily calciifed coronary lesions and does not affect distal branch vessels.