血管内超声指导下对冠状动脉严重钙化病变行旋磨介入治疗疗效评估

目的评估血管内超声（IVUS）指导下冠状动脉旋磨术联合药物洗脱支架（DES）治疗严重钙化病变的疗效。方法 13例冠状动脉严重钙化患者在IVUS指导下行冠状动脉旋磨及支架置入术,评估手术即刻成功率、术后管腔最小直径、最小直径狭窄率、管腔有效面积变化及随访结果。结果 13例中,单支病变1例（7.7%）,双支病变3例（23.1%）,三支病变6例（46.2%）,左主干＋三支病变1例（7.7%）,左主干病变2例（15.4%）。术前、术后肌钙蛋白T、肌酸激酶同工酶与肌酸酐比较,差异无统计学意义。靶血管管腔最小直径由术前（2.0±0.3）mm增大至术后的（3.6±0.8）mm,直径狭窄率由术前的（74.5±6.8）%减少至术后的（20.3±12.5）%,管腔有效面积由术前的（4.0±1.4）mm2增大至术后的（10.7±5.5）mm2,差异均有统计学意义。即刻手术成功率100%,术后随访期间无心绞痛再发、心肌梗死及靶血管再次血运重建。结论 IVUS指导下冠状动脉旋磨术联合DES可安全用于冠状动脉严重钙化病变患者,提高了介入手术的成功率。

Efficiency of rotational atherectomy with drug-eluting stents by intravascular ultrasound for heavily calcified lesions

Objective To evaluate the efficiency of rotational atherectomy（ RA） with drug-eluting stents（ DES） by intravascular ultrasound（ IVUS） for heavily calcified lesions. Methods Thirteen patients with heavily calcified coronary artery underwent the treatment of RA and DES by IVUS. We wanted to observe the immediate success rate,the minum lumen diameter,diameter stenosis rate,effective area of the lumen, and the follow-up results. Results All 13 patients in accordance with angiography and IVUS examination were confirmed as severe calcification,including single-vessel disease 1 case（ 7. 7%）,double vessel disease in 3 cases（ 23. 1%）,three lesions 6 cases（ 46. 2%）,left main artery ＋ three lesions 1 case（ 7. 7%）,left main artery disease 2 cases（ 15. 4%）,were successfully carried out percutaneous coronary intervention（ PCI）. PCI immediate success rate was 100% and the minimum lumen diameter was changed from（ 2. 0 ± 0. 3） mm preoperative to（ 3. 6 ± 0. 8） mm postoperative（ P 0. 05）. The minimum diameter stenosis rate preoperatively decreased from（ 74. 5 ± 6. 8） % to（ 20. 3 ± 12. 5） %（ P 0. 05）. The effective area of the lumen from（ 4. 0 ± 1. 4） mm2increase of（ 10. 7 ± 5. 5） mm2postoperative（ P 0. 05）. Follow-up（ 6. 7 ±1. 7） months,no patients had angina,myocardial infarction,target vessel revascularization required. Conclusions Coronary intravascular ultrasound guided rotational atherectomy combined with drug-eluting stents can be safely used in patients with severely calcified coronary artery disease,improve the success rate of PCI.