冠状动脉旋磨术在冠心病钙化病变介入治疗中的应用

目的探讨冠状动脉旋磨术治疗冠状动脉钙化病变的安全性及有效性。方法回顾性分析12例行冠状动脉旋磨术结合冠状动脉球囊成形术和支架植入术的冠状动脉粥样硬化性心脏病(冠心病)患者的临床资料,着重分析手术方法、手术成功率、术后随访主要心血管事件(包括心源性死亡、心肌梗死、靶病变血运重建)的发生率。结果 12例患者共有16处钙化病变,有15处钙化病变行冠状动脉旋磨术,管腔狭窄由术前的87%±10%减少至42%±9%,结合冠状动脉球囊成形术,共植入18枚国产药物支架,手术成功率为93.75%(15/16)。1例因血管严重扭曲,球囊扩张后出现冠状动脉夹层,植入支架失败,建议行外科冠状动脉旁路移植术。术中均无主要并发症(包括心源性死亡、Q波心肌梗死、急诊冠状动脉旁路移植术)发生。所有患者随访(8.4±3.6)个月,有2例再发心绞痛,无主要心血管事件(包括心源性死亡、心肌梗死、靶病变血运重建)发生。5例患者复查冠状动脉造影,有1例出现支架内再狭窄30%。结论冠状动脉旋磨术联合球囊扩张和支架植入术治疗冠状动脉钙化病变可取得很高的手术成功率,是治疗钙化病变安全、有效的方法。

Clinical application of rotational atherectomy in coronary artery calcification lesions

Objectives To investigate the safety and efficacy of coronary rotational atherectomy in the treatment of coronary artery calcification lesions. Methods Clinical data of 16 lesions in 12 patients diagnosed as coronary artery atherosclerosis by angiography were treated with coronary rotational atherectomy combined with percutaneous transluminal coronary angioplasty （PTCA） and stent implantation were retrospectively analyzed. Procedural success rate and clinical effect of postoperative visiting and main adverse cardiovascular events （including cardiac death, myocardial infarction and target lesion revascnlarization）were recorded and focused on. Results Fifteen lesions were treated with coronary rotational atherectomy, wilose mean proportion of stenosis was decreased from 87%±10% to 42%±9%. PTCA and stent implantation were performed and 18 stents were implantated. Procedural success was achieved with 93.75% （15/16） for 1 case was with coronary dissection after balloon dilation because of serious buckling of vessel and failed implantation. The failed case was suggested coronary artery bypass. No main adverse cardiovascular events（including cardiac death,Q wave myocardial infarction and emergency coronary surgery） occurred during operation. Angina was appeared in 2 cases and no major adverse cardiac events （including cardiac death, myocardial infarction and target lesion revaseularization）oeeurred during follow-up for （8.4±3.6）months.The re-examination of the 5 eases by coronary angiography after operation suggested that there were 30% in-stent restenosis appeared in one of them. Conclusions Coronary rotational atherectomy combined with PTCA and stent implantation was effective and safe in the treatment of coronary artery calcification lesions. It presented a high procedural success rate.