经皮高速旋磨治疗冠状动脉钙化分叉病变：单中心经验

目的 评价旋磨术在冠状动脉钙化分叉病变治疗中的作用.方法 选择2006年7月至2013年1月大庆油田总医院旋磨治疗冠状动脉分叉病变患者48例,术后观察冠状动脉造影和治疗结果、住院期间和12个月的主要不良心血管事件（包括心源性死亡、介入治疗相关心肌梗死和靶血管再次血运重建）以及心绞痛的发生情况.结果 43例（89.6％）只旋磨主支,4例（8.3％）同时旋磨主支和边支,1例（2.1％）只旋磨边支.1例旋磨术中发生急性闭塞,1例旋磨术中出现慢血流；43例（89.6％）只在主支置入支架,4例（8.3％）采用双支架术,1例（2.1％）只在边支置入支架.主支置入支架后3例边支发生急性闭塞,1例边支次全闭塞,边支闭塞后球囊扩张边支,血流均恢复TIMI Ⅲ级.住院期间无死亡和靶血管再次血运重建病例,共有6例（12.5％）发生介入治疗相关心肌梗死.术后12个月随访1例非心源性死亡,1例靶血管再次血运重建,无心源性死亡、心肌梗死病例.结论 经皮冠状动脉内旋磨术是治疗分叉病变的安全、有效方法.

High-speed rotational atherectomy treat calcified bifurcation coronary lesion

Objective To assess the application of rotational atherectomy in improving the success rate and outcome of calcified bifurcation coronary lesion. Methods Between July 2006 and January 2013, 48 consecutive patients with calcified bifurcation lesions meeting the Medina classification. Results Forty-three （89.6%） patients underwent rotational atherectomy of the main-vessel alone; 4（8.3%） underwent rotational atherectomy of the both the main vessel and the side- branch ostium and 1（2.1%） underwent rotational atherectomy of the side-branch ostium alone. One acute occlusion, and one no-flow phenomena happened during rotational procedure. Most of the patients （n=43, 89.6%） had a drug-eluting stent placed in the main vessel after rotational atherectomy; 4 patients （8.3%） required two-stent technique and 1 patients （2.1%） required side-branch stent. After placing the main vessel stent 3 patients had side- branch acute occlusion, 1 had sub-total occlusion. After balloon dilated, all side-branches was restored TIMI III flow. PCI-related MI rate was 12.5%. Major adverse cardiac events was rare included cardiac death （n=0; 0%）, nonfatal myocardial infarction （n=0; 0%） and target lesion revascularization （n=l; 2.1%） during the 12 months follow-up period. Conclusions Rotational atherectomy with provisional stenting provided a safe and effective means of treating calcified bifurcation lesions.