Directional coronary atherectomy for lesions of the proximal left anterior descending artery: initial clinical results, complications and histopathological findings

Background: Directional coronary atherectomy is a percutaneous technique which extends the role of balloon angioplasty to bulky eccentric coronary lesions. Aims: To report the early experience, clinical results, complications and histopathological findings of directional coronary atherectomy (DCA) in proximal left anterior descending artery (LAD) stenosis. Methods: Study of 25 lesions in 24 patients on whom directional atherectomy was performed on the proximal LAD artery with the Simpson coronary atherectomy device. Results: Twenty-five procedures were performed on 24 patients with stenosis in the proximal LAD artery. There were 21 males and three females with a mean age of 56.5 years. Sixteen patients presented with stable angina and eight with unstable angina. Eight patients had previous myocardial infarction (MI). Angiographic success was obtained in 24 of 25 lesions (96%). The mean lesion length was 13.1 ± 3.7 mm and the mean LAD artery diameter was 3.6 ± 0.5 mm. Minimal luminal diameter improved from 0.9 ± 0.4 mm to 3.0 ± 0.5 mm and the percentage diameter stenosis reduced from 75 ± 12% to 16 ± 9%. Complications included acute occlusion in one patient, non-Q MI in three patients, local vascular complications in one patient and side-branch loss in one patient. Histology demonstrated fibrous cap of atherosclerotic plaque in 100%, media and internal elastic lamina in 28% and intimal hyperplasia in 100% of restenotic lesions and 27% of native lesions. Restenosis rates in angiographically restudied patients was 27%. The mean minimal luminal diameter at follow-up was 2.3 ± 0.9 mm and the mean percentage diameter stenosis was 35 ±21%. Conclusion: From this initial study, we conclude that DCA is an effective and safe procedure for the treatment of large proximal LAD lesions. DCA provides a large luminal diameter and a ‘smoother’ angiographic appearance compared to coronary angioplasty. Acute complication rates are low and restenosis rates were comparable with percutaneous transluminal coronary balloon angioplasty.     

经皮桡动脉冠状动脉造影及冠状动脉成形术的临床应用

目的 :评价经皮桡动脉冠状动脉造影术与冠状动脉腔内成形术 (PTCA)的临床应用价值。方法 :有选择性的对 37例患者行经皮桡动脉途径冠状动脉造影及冠状动脉成形术 ,观察其疗效和血管并发症。结果 :1 桡动脉穿刺成功率为 93 8% (有 2例失败 )。 2 14例冠状动脉造影正常 ,17例冠状动脉造影显示 2 6处存在≥ 70 %的狭窄病变 ,适合行冠状动脉介入手术。 2 6处病变有 4处PTCA疗效满意 ,2 2处行PTCA +支架术 ,植入支架 31只。狭窄从 (81± 12 ) %降低至 (10 6± 7 4 ) % ,最小血管直径由 (0 86± 0 12 )mm增加至 (3 0 8± 0 32 )mm。 6例病人行冠状动脉旁路移植术。 3 所有患者术后即拔导管鞘 ,局部压迫 4h。术后并发症的发生率为 3 3% (1例术后的桡动脉闭塞 )。结论 :经桡动脉途径行冠状动脉造影及冠状动脉成形术安全可行 ,其具有穿刺部位出血少、住院时间短的特点 ,可选择性的应用于某些冠心病患者。     

Angiographic analysis of immediate and long-term results of PTCR vs. PTCA in complex lesions (COBRA study).

We conducted a prospective, randomized trial to compare immediate and long-term effects of percutaneous transluminal coronary angioplasty (PTCA) and high-frequency rotational atherectomy (PTCR) in patients with angiographically predefined complex coronary artery lesions (AHA type B2 and C). The relation of lesion characteristics to procedural results is reported in this angiographic analysis. Patients were randomly assigned to balloon angioplasty (n = 250 patients) or rotational atherectomy (n = 252 patients). Quantitative coronary angiography could be performed in 447 patients to evaluate immediate results and in 293 patients with a 6-month angiographic follow-up. Procedural success was comparable in the PTCR and in the PTCA group (80% vs. 76%, P = 0.260). The need for stent implantation due to a residual stenosis >50% or a bail-out situation was significantly higher in the PTCA group (9.7% vs. 2.0%, P = 0.001). In both treatment groups, diameter stenosis was effectively reduced and MLD increased. The acute gain did not differ between the two groups. At 6-month control, the restenosis rate was comparable in the PTCR and in the PTCA group (37% vs. 35%, P = 0.658), whereas diameter stenosis was significantly more severe in the PTCR group than in the PTCA group (52% vs. 46%, P = 0.039) and, correspondingly, the MLD was significantly smaller in the PTCR group (1.29 mm vs. 1.44 mm, P = 0.031). Late loss was about the same in both groups, however, net gain and net gain index were significantly higher in the PTCA group (0.82 mm vs. 0.64 mm, P = 0.008; and 31% vs. 24%, P = 0.009). Analysis of procedural results for various lesion characteristics revealed no significant difference between treatment groups. In this randomized trial, complex coronary artery lesions were treated with comparable results for angiographic and procedural success and the restenosis rate by both, PTCA and PTCR. Late loss, however, was significantly higher and net gain significantly smaller after PTCR. Stents, although infrequently used, had a relevant impact on immediate PTCA results but not on late results. Cathet Cardiovasc Intervent 2001;53:359-367.     

Coronary angioplasty in cardiac transplant recipients

Accelerated coronary artery disease following cardiac transplantationremains an important obstacle to long-term survival and thecorrect management strategy remains unclear. This observational,prospective study was designed to examine the feasibility ofusing percutaneous transluminal coronary angioplasty (PTCA)in the treatment of post-transplant coronary disease. Thirteen consecutive patients were selected from the total populationof 276 transplant recipients who underwent routine coronaryangiography between 1987 and 1990. Selection of patients wason angiographic criteria alone and PTCA was performed to allaccessible stenoses with more than 80% luminal narrowing. PTCAwas performed using standard angioplasty equipment and procedureas considered appropriate for the individual lesion. A successfulPTCA was defined as more than 30% reduction in luminal narrowingand a residual narrowing of less than 50%. Restenosis was definedas a loss of 50% or more of the gain achieved at the time ofsuccessful PTCA or more than a 30% increase in narrowing atthe site of stenosis. A total of 31 lesions were dilated inthis group and a successful result was achieved in 29 of these(93%) and in 12 of the 13 patients. The one patient with failedPTCA underwent later successful coronary artery bypass graftingto complete revascularization. Four of the 13 patients havehad two angioplasty procedures, two for restenosis and two fordisease progression in other sites. One patient died 15 monthsafter the initial PTCA and remaining 12 were asymptomatic withgood exercise tolerance and ventricular function at a mean of19 months (range 1–39 months) following first PTCA. Thus, PTCA can be considered a feasible form of treatment forsignificant single and multiple vessel disease in selected cardiactransplant recipients. Further study is required to assess theeffect of this early intervention on long-term mortality.     

Safety and efficacy of cutting balloon angioplasty: the Mayo Clinic experience

A number of evolving clinical indications for cutting balloon angioplasty (CBA) have been described in the clinical literature, including angioplasty-resistant stenoses, in-stent restenosis, ostial lesions and small vessel disease. METHODS: We analyzed the Mayo Clinic PTCA registry and report procedural and in-hospital clinical outcomes in 100 patients (103 procedures, 114 lesions) undergoing CBA. RESULTS: CBA was successfully completed in 109 lesions (96%). The majority of lesions (73%) required additional treatment with either balloon angioplasty (39%) or stent implantation (34%). Severe intimal dissection resulting in at least 50% luminal obstruction occurred in 13 lesions (11%). A single incident of branch occlusion was documented, resulting in ST elevation myocardial infarction. There were no incidents of vessel perforation, urgent percutaneous or surgical target vessel revascularization, or in-hospital death. CONCLUSION: CBA is feasible and safe, with a low incidence of procedural complications and in-hospital adverse cardiac events when used primarily for in-stent restenosis.     

Comparison of quantitative coronary angiographic results after directional coronary atherectomy and balloon angioplasty of protected left main coronary stenosis

We compared the angiographic and clinical outcomes after directional coronary atherectomy (DCA, 13 patients) with those after conventional balloon angioplasty (BA, 21 patients) in patients with protected left main coronary artery stenosis. The initial success rate was 100% in the DCA group and 81% (17 of 21) in the BA group. Restenosis was present in 2 of 11 patients in the DCA group and 9 of 16 patients in the BA group (18% vs. 56%, P < 0.05). DCA and BA improved a minimal lumen diameter. The initial gain after DCA was greater than that after BA. At follow-up, the minimal lumen diameter was larger and the percentage diameter stenosis was smaller in the DCA group than in the BA group. The late loss and loss index were equivalent in both groups. Compared with conventional BA, DCA in protected left main coronary artery stenosis is associated with a higher angiographic success rate and provides a wider luminal diameter with reduced incidence of restenosis. Cathet. Cardiovasc. Diagn. 44:138–141, 1998. © 1998 Wiley-Liss, Inc.     

经皮腔内冠状动脉成形术后再狭窄的临床多因素分析

目的:通过对再狭窄和临床易患因素关系的分析,希望找出再狭窄的独立预测因素.方法;本研究回顾性分析了50例(共61支血管)在我院成功进行了PTCA术,并于术后6个月有完整冠状动脉造影随访资料的病人,通过单因素及多因素方法分析再狭窄与临床因素的关系.结果:再狭窄率为49.2%(30/61).单因素分析中发现病变AHA/ACC分型B和C型、长病变、术前直径狭窄百分比较大、术前最小管腔直径较小组的再狭窄率高,以上4个因素和再狭窄的关系有显著统计学意义(P<0.01).球囊最大充气压较大和梗塞相关血管的再狭窄率较高,以上2因素和再狭窄的关系有统计学意义(P<0.05).多元Logistic回归分析结果显示病变分型为B和C型、梗塞相关血管、最大球囊充气压较大可使再狭窄率增高.结论:病变分型、梗塞相关血管、球囊最大充气压力再狭窄的独立预测因素.     

Immediate and chronic results of cutting balloon angioplasty: A matched comparison with conventional angioplasty

Background: At the initial stages of percutaneous transluminal coronary angioplasty (PTCA), several studies reported on the feasibility of coronary artery incision and dilatation leading to the extension of the PTCA technique. Hypothesis: This study was designed to determine the immediate and chronic results of cutting balloon (CB) angioplasty. Methods: This procedure was performed on 127 lesions in 110 patients (male 83%, age 61.8 ± 9.3 years). Results: The overall procedural success rates for the CB were 93.7% (119 lesions) and 92.7% (102 patients), while solitary CB without pre- and/or postdilatation was 76.4% (91 lesions). There was one major in-hospital complication (Q-wave myocardial infarction, 0.9%), but there were no deaths or emergency coronary artery bypass graftings. Significant angiographic dissections (≥ grade C) occurred in four patients, and coronary perforation occurred in one. The successfully treated CB group (95 lesions) was matched with the successful conventional angioplasty group (PTCA group) for chronic result assessment in regard to reference vessel size and lesion characteristics. In the CB group, postprocedural minimal luminal diameters were significantly larger and the percentage of stenosis at the stenotic site was significantly lower compared with the PTCA group. Restenosis occurred in 22 lesions (23.1%). This showed a significantly lower restenosis rate compared with the PTCA group (42.1%). In addition, the restenosis rate of the CB without inclusion of the pre- and/or postdilatation-treated lesions was 19.7%. Conclusions: (1) Cutting balloon angioplasty procedures can be performed with high success rates with few major in-hospital events. (2) The restenosis rate in the CB group was significantly lower compared with the PTCA group.     

Risk factors for later restenosis after successful coronary angioplasty: Mitsui Memorial Hospital experience]

To determine the risk factors for restenosis, 170 patients with 245 stenotic lesions who underwent follow-up coronary angiography after successful coronary angioplasty (PTCA) were evaluated. The mean angiographic follow-up period was 116 +/- 39 days (+/- SD). Restenosis was defined according to 3 criteria: 1) greater than or equal to 50% loss of the gain achieved by PTCA, 2) greater than or equal to 60% stenosis at follow-up, 3) greater than or equal to 30% increase in stenosis from post-PTCA. The rate of restenosis was 41.2% by criterion 1), 32.2% by criterion 2) and 34.3% by criterion 3). By univariate analysis of 12 clinical, 9 angiographic and 8 procedural factors, 6 factors were significantly associated with restenosis: 1) left anterior descending artery, 2) severe stenosis before PTCA, 3) long lesions, 4) calcified lesions, 5) maximal inflation pressure greater than or equal to 100 psi, 6) number of inflations greater than or equal to 6 times. No clinical factors were suggested to have significant influence on restenosis. Multivariate analysis (stepwise method) revealed independent 6 factors related to restenosis in the following order of importance: 1) number of inflations, 2) maximal inflation pressure, 3) presence of calcification, 4) vessel dilated at PTCA, 5) diabetes mellitus, 6) lesion length. The residual stenosis had no significant influence on restenosis. This may have been due to a small number (14.7%, 36 lesions) of prominent residual stenoses (greater than or equal to 40%) in this study. The presence or absence of intimal disruptions had no significant influence on restenosis. It was suggested that restenosis after successful PTCA may be influenced mainly by "local factors" related to regions.     

Acute results and long-term outcome of transluminal extraction catheter atherectomy for saphenous vein graft stenoses

Distal embolization of atheroma and thrombus is a major concern when performing balloon angioplasty in coronary saphenous vein grafts (SVGs). The transluminal extraction catheter (TEC) is designed to remove this material and may improve the safety of percutaneous treatment of SVG disease. We assessed the acute results and long-term outcome of 67 patients (mean age 65.6 ± 8.1 years; range 47–83 years) who underwent 73 separate TEC atherectomy procedures. Eighty-eight SVG lesions were treated (mean age 8.7 ± 3.8 years from bypass surgery). Procedural success (< 50% final diameter stenosis and absence of major complications) was obtained in 63 patients (86%). Adjunctive balloon angioplasty and/or directional coronary atherectomy was required in 69 of the procedures (95%). Major complications, occurring in 8 patients (ll%), were acute closure in 4 (5%), resulting in Q-wave myocardial infarction in 3 and urgent bypass surgery in 1, and distal embolization in 4 (5%; 1 associated with Q-wave myocardial infarction). Angiographic follow-up was available for 50 patients and restenosis was present in 26 (52%). These data suggest TEC atherectomy can be performed in SVGs with an acceptable procedural risk, but restenosis remains a significant limitation which will require other strategies to overcome. o 1994 Wiley-Liss, Inc.     

Importance of stenosis morphology in the estimation of restenosis risk after elective percutaneous transluminal coronary angioplasty

To determine the importance of predilatation stenosis morphology on the risk of restenosis after percutaneous transluminal coronary angioplasty (PTCA), 500 procedures were randomly chosen for analysis from 3,839 consecutive successful PTCA procedures. Angiographic follow-up was available for 308 patients (62%) at a mean of 7.3 +/- 3.4 months after PTCA. One dilated site was randomly chosen per procedure. One hundred and one sites had documented restenosis (greater than or equal to 50% mean diameter stenosis from multiple projections) by quantitative angiography (33% of all sites restudied and 20% of all sites dilated). Twenty-eight morphologic variables and 20 other angiographic, clinical and procedural variables were analyzed by an observer blinded to clinical outcome. Univariate analysis found post-PTCA percent stenosis greater than 30% (p = 0.005), bend point location (p = 0.01), post-PTCA gradient greater than 15 mm Hg (p = 0.02), angina class III to IV (p = 0.03), age (p = 0.04) and the absence of dissection (p = 0.04) to predict restenosis. Multivariate analysis found only 2 significant (p less than 0.05) independent predictors of restenosis: post-PTCA percent stenosis greater than 30% and bend point location. Restenosis occurred in 41% of lesions located at an end-diastolic vessel angle greater than or equal to 45 degrees compared with 28% in lesions on lesser bends. Thus, only 1 predilatation morphologic characteristic, stenosis location at a bend point, was an important independent predictor of restenosis, and should be considered when assessing patients for PTCA.     

小冠状动脉狭窄性病变的介入治疗

目的 :探讨小冠状动脉 （直径 <3 mm）狭窄性病变实施普通球囊、切割球囊或小支架介入治疗的疗效和并发症。方法 :小冠脉狭窄性病变介入治疗 （PCI）患者 13 6（男 87,女 49）例 ,年龄 3 2～ 85（54± 17）岁。根据手术方法分为普通球囊组、切割球囊组和小支架组。残余狭窄率 <3 0 %且无动脉夹层、撕裂等并发症者为手术成功 ,术后 6个月复查冠脉造影。结果 :普通球囊组 3 2例 ,手术成功 2 6例 （81% ） ,出现动脉夹层或扩张不满意改支架术 6例 （2 4% ）。切割球囊组 48例 ,手术成功 43例 （90 % ） ,出现动脉夹层或扩张不满意改支架术 3例 ,出现造影剂血管外漏 2例。支架组 56例 ,手术成功 53例 （95% ） ,出现造影剂血管外漏 2例 ,出现心包填塞抢救成功 1例。3组均未出现血管急性闭塞。术后 6个月 ,切割球囊组、小支架组、普通球囊组冠脉造影狭窄率分别为 2 3 % （11例 ）、16% （9例 ）、3 8% （12例 ）。结论 :小冠脉狭窄性病变实施介入治疗能取得显著效果 ,小支架术优于普通球囊扩张术 ,切割球囊扩张与普通球囊扩张具有近似疗效     

Immediate and 3-month follow-up outcome after cutting balloon angioplasty for bifurcation lesions

Balloon angioplasty of a bifurcation lesion is associated with lower rates of success and higher rates of complications than such treatment of lesions of most other morphologies. To date, the best device or procedure for bifurcation lesions has not been determined. The aim of this study was to compare the immediate and 3-month follow-up outcome of cutting balloon angioplasty (CBA) versus conventional balloon angioplasty (PTCA) for the treatment of bifurcation lesions. We treated 87 consecutive bifurcation lesions with CBA (n = 50) or PTCA (n = 37). Paired angiograms were analyzed by quantitative angiography, and angiographic follow-up was achieved for 93% of the lesions. The procedural success was 92% in the CBA group and 76% in the PTCA group (P < 0.05). Major in-hospital complications occurred in two lesions in the CBA group and six in the PTCA group (P = 0.05). The incidence of bail-out stenting in the CBA group was lower than in the conventional PTCA (8% vs 24%, P < 0.05). At the 3-month follow-up, the restenosis rate was 40% in the CBA group versus 67% in the PTCA group (P < 0.05). Clinical events during follow-up did not differ between the two groups. In conclusion, in comparison with PTCA, procedural success was greater and the restenosis rate lower with CBA. The results of this study support the use of the cutting balloon as optimal treatment for bifurcation lesions. (J Interven Cardiol 2004;17:1–7)     

Right coronary ostial atherectomy: A really close shave

Percutaneous transluminal coronary balloon angioplasty (PTCA) has had limited success with higher complication and restenosis rates in aorto-ostial lesions. Directional coronary atherectomy (DCA) has been advocated as an alternative to PTCA in such lesions. In this report, we describe a potential complication of DCA in right coronary ostial lesions.     

Long-term clinical outcome after implantation of medium Palmaz (biliary) stents in very large native coronary arteries.

Intracoronary stenting has been shown to improve acute and long-term clinical results compared with coronary angioplasty. However, clinical outcome after medium Palmaz biliary (PB) stent implantation in very large native coronary arteries (> 4 mm in diameter) is unknown. This study evaluated restenosis and long-term clinical outcome after PB stenting in large native coronary arteries. Between June 1993 and December 1998, 55 patients with 56 lesions were treated with PB stents. Intracoronary stent deployment was successful in all 56 vessels attempted (100%). The mean stenosis was reduced from 65% +/- 10% to 4% +/- 14%. In 48 of the 56 vessels (86%), vessel size was greater than 4.0 mm in diameter and the mean reference vessel diameter was 4.73 +/- 0.7 mm after stenting. Angiographic success was achieved in 100%. Five patients had postprocedural cardiac enzyme elevation. There was no periprocedural death, emergency coronary artery bypass surgery, repeat target lesion revascularization, or acute stent thrombosis. Long-term clinical follow-up at mean of 28 +/- 15 months was obtained in 96% of the patients. Clinical restenosis rate occurred in 18% of ostial (6/34) and 0% of nonostial (0/22) lesions (P < 0.0001) with an overall clinical restenosis rate of 11%. Repeat angioplasty were performed in these six patients. There were three cardiac and three noncardiac deaths. The overall event-free survival at 1 and 3 years was 92% +/- 4% and 80% +/- 6%, respectively. PB stent implantation in very large native coronary arteries can be performed with a high degree of procedural success and low in-hospital complications. The long-term clinical outcome of patients undergoing PB stenting is associated with excellent event-free survival. However, stenting of ostial lesions remains as an important factor for restenosis even in very large coronary artery stenting.     

Directional coronary atherectomy: acute results and angiography follow-up in 42 treated patients

We used directional coronary atherectomy (DCA) as a therapeutic option for coronary lesions unsuitable for PTCA (eccentric, ostial, branching or restenotic) and as "rescue device" for failed PTCA. Forty-two patients were treated by DCA using the Simpson coronary atherectomy device, including four female and 38 male patients with an average age of 55.7 years. Atherectomy as primary intervention was performed in 16 patients (Group I), because morphology of their lesions was assumed to be unsuitable for PTCA. DCA was also used after failed balloon dilatation in eight patients with unsuccessful, but uneventful treatment (Group II). In 18 cases (Group III) DCA was performed as "rescue procedure" after failed PTCA and resulting critical ischemia (local dissection, signs and symptoms of ongoing ischemia, occlusion after PTCA). Target lesions were located in LM 1, LAD 33, RCA 9, CABG 3. Mean length of lesion was 8.1 mm (2-25 mm). The overall success rate for 46 lesions was 93%. Mean stenosis was reduced from 92% to 17% in cases with primary success. Presently, available follow-up angiography (24) showed six restenoses (defined as greater than 50% stenoses). Major complications occurred in seven cases (death: 0, MI: 2, CABG within 24 h: 5; 3 in Group III). "Rescue indication" (Group III) after failed balloon dilatation procedure showed a favorable primary result with a success rate of 78%; only three cases of this group needed CABG. Our results show that DCA is a safe and effective technique which can extend the indication for percutaneous procedures and gives a successful nonoperative option in cases of failed PTCA.     

Directional coronary atherectomy: optimal atherectomy trials and new combined strategies with coronary stents.

Directional coronary atherectomy (DCA) has evolved from its early use as a tool for minimal plaque debulking to its current use of more aggressive lumen enlargement. The trend toward improved lumen results and reduced restenosis following DCA compared to percutaneous transluminal coronary angioplasty (PTCA) in the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) was confirmed as a significant improvement in the subsequent Balloon versus Optimal Atherectomy Trial (BOAT). BOAT showed that acute lumen results and late angiographic restenosis could be significantly improved by DCA over PTCA, without any increase in procedural complications or late cardiac events. The role of DCA in conjunction with coronary stents is currently being defined as studies suggest that residual plaque burden after stenting is predictive of late restenosis. The Atherectomy before Multilink Stent Improves Lumen Gain and Clinical Outcomes Study (AMIGO) will help determine whether plaque debulking prior to stenting can reduce restenosis.     

Minimally invasive angioplasty: acute and long term results of low pressure dilatation with a non-compliant balloon during percutaneous transluminal coronary angioplasty

Despite technological advances in angioplasty equipment and increased operator experience, the incidence of dissection and abrupt closure remains unchanged. To test the hypothesis that a different balloon inflation strategy may influence the degree of arterial trauma, and therefore reduce the incidence of major complications, the success rate, acute complications and incidence of restenosis were analyzed in 110 consecutive patients using a non-compliant dilatation catheter. The term "minimally invasive angioplasty" has been coined to describe a strategy of minimizing arterial trauma by using the lowest possible inflation pressures during percutaneous transluminal coronary angioplasty (PTCA). Lesion analysis using a modified American College of Cardiology/American Heart Association Classification showed that 37% of lesions were Type A, 40% were Type B, and 23% were Type C. Overall, PTCA success was achieved in 98% of lesions. Major dissection and abrupt closure occurred in 1%. No patient required emergency coronary bypass surgery and there were no deaths. The mean coronary stenosis was reduced from 85% to 18.4%. In 75% of lesions, inflation pressures of 5 atmospheres (atm) or less were used. Angiographic follow-up was available in 80 (73%) of the patients and restenosis occurred in 19 (24%). Thus, minimally invasive angioplasty, a technique which may reduce arterial trauma, results in a high primary success rate; low residual stenosis; and very low incidence of abrupt closure, major dissection and perhaps lower restenosis. These data suggest the need for further study of PTCA techniques designed to minimize arterial trauma.     

冠状动脉旋磨术及经皮冠状动脉成形术在复杂病变介入治疗中的应用

目的　探讨冠状动脉旋磨术 (Rotational atherectomy)及经皮腔内冠状动脉成形术 (Percutaneous translum i-nal coronary angioplasty PTCA)治疗复杂冠脉病变的临床效果。方法　对 15例患者的 2 0处病变行冠脉旋磨术及经皮腔内冠状动脉成形术 (PTCA)治疗 ,部分病例并在血管内超声指导下进行 ,观察其治疗的即刻成功率及并发症率。结果　 15例施行冠状动脉旋磨术的患者 ,旋磨头均成功地通过了病变 ,平均狭窄程度由 88.30 %± 7.5 4 %降至15 .6 0 %± 10 .75 %。其中 6 0 .0 0 %的病例选择了 1.5 mm的旋磨头 ,13.33%的病例使用了 2个旋磨头。全部病例均联合应用了 PTCA,13例在行旋磨术后置入冠脉内支架 (余下 2例为支架内再狭窄病例 )。 1例患者术中发生较严重的冠状动脉痉挛 ,经冠状动脉内给予硝酸甘油后缓解 ;2处 (10 .0 0 % )病变出现了 B型以上的内膜撕裂 ,出现缓慢血流现象发生率为 3.8%。无急诊冠状动脉搭桥及死亡病例。结论　冠状动脉旋磨术及 PTCA可选择性用于复杂冠状动脉病变 ,尤其是严重钙化病变 ,小血管长节段病变