冠状动脉旋磨术联合药物涂层球囊治疗冠状动脉严重钙化病变的疗效

目的:探索冠状动脉(冠脉)旋磨术(RA)联合药物涂层球囊(DCB)治疗严重冠脉钙化病变的疗效。方法:连续入选2018年5月—2021年7月就诊于郑州大学第一附属医院因冠脉严重钙化行RA的患者318例,根据不同治疗方案分为RA/DCB组(57例)和RA/药物洗脱支架(DES)组(261例)。比较两组一般临床资料、冠脉病变特征、术中并发症、院内不良事件、随访期间主要心脑血管不良事件(MACCE)发生率。结果:两组基线临床资料、术中并发症、院内不良事件均差异无统计学意义。RA/DES组较多合并左主干病变、分叉病变、弥漫性病变等复杂解剖类型(均P<0.05)。随访期间RA/DES组MACCE(18.77%vs.12.28%)及靶病变血运重建(13.79%vs.7.02%)发生率较RA/DCB组升高,但差异无统计学意义。多因素Cox回归分析显示,分叉病变(HR=2.284,95%CI:1.063～4.908,P=0.034)、植入物总长度(HR=1.023,95%CI:1.005～1.047,P=0.014)、SNYTAX评分(HR:1.047,95%CI:1.013～1.082,P=0....     

冠状动脉旋磨术联合药物洗脱支架治疗冠状动脉严重钙化病变的临床研究

目的:评价冠状动脉旋磨术(rotational atherectomy,ROTA)联合药物洗脱支架(drug eluting stent,DES)治疗冠状动脉严重钙化病变的疗效及中期随访结果。方法:对2009-01至2011-02连续的24例冠心病患者严重钙化病变行ROTA加DES治疗,其中经股动脉路径14例,经桡动脉路径10例,观察其旋磨特点、即刻造影成功率、临床成功率、院内事件发生率和平均随访12个月(6～24个月)的结果。结果:行ROTA的患者均为美国心脏病学会/美国心脏病协会(AHA/ACC)B2/C型严重钙化病变。旋磨头均成功通过狭窄病变,并完成DES置入术,91.7%(22/24)的病例最后使用≤1.5 mm旋磨头通过钙化病变,总成功率为100%,术中仅1例发生慢血流和心动过缓,院内无非Q波心肌梗死发生,无冠状动脉穿孔、急诊冠脉旁路移植术及死亡发生。随访期间无主要心脏不良事件(MACE)。结论:选用直径较小的旋磨头改变钙化病变的血管的顺应性后,可以顺利完成DES植入术,中期效果满意。     

旋磨术联合药物洗脱支架治疗冠状动脉内膜中度钙化的疗效

目的探讨旋磨术联合药物洗脱支架治疗冠状动脉内膜中度钙化的临床疗效及患者术后的影响。方法冠状动脉内膜中度钙化患者147例。按照治疗方式的不同分为治疗组73例和对照组74例,其中治疗组予以旋磨术联合药物洗脱支架治疗,对照组行药物洗脱支架治疗。对所有患者均进行为期1年的随访。观察两组手术成功率、再狭窄率;治疗后7 d肌钙蛋白T(Tn T)、血清肌酸激酶同工酶(CK-MB)及血肌酐(SCr)水平变化及1年内主要心脏不良事件(MACE)发生情况。结果治疗组手术成功率高于对照组再狭窄率、MACE发生率低于对照组(均P<0.05)。治疗前两组血清Tn T、CK-MB及SCr水平比较无统计学差异(P>0.05)。治疗后治疗组均低于对照组(均P<0.05)。结论旋磨术联合药物洗脱支架治疗冠状动脉内膜中度钙化的疗效显著,可有效降低患者MACE发生风险,同时不会对患者的炎症反应及心肌细胞功能产生严重影响。     

旋磨联合支架治疗31例严重钙化冠状动脉的临床特点分析

目的　评估严重钙化冠状动脉行旋磨联合药物洗脱支架的临床疗效。方法　通过回顾性分析31例因严重钙化冠状动脉行旋磨介入治疗的患者,其中13例在血管内超声（IVUS）指导下进行,分析其临床特点,观察手术即刻成功率、住院期间及长期心血管事件随访结果。结果　31例患者平均年龄71.81±10.70岁,其中男性22例,女性9例,经造影证实为严重钙化冠状动脉,其中造影证实单支病变2例（6.5%）,双支病变7例（22.6%）,三支病变15例（48.4%）,左主干＋三支病变1例（3.2%）,左主干病变6例（19.4%）。旋磨靶血管中左主干-左前降2例（6.5%）,左前降支22例（70.9%）,左回旋支2例（6.5%）,左前降支＋左回旋支1例（3.2%）,右冠状动脉4例（12.9%）。术中需主动脉球囊反搏保护1例（3.2%）,冠状动脉夹层6例（19.4%）,慢血流2例（6.5%）,但31例患者均成功实施了旋磨及支架植入术,术前、术后血肌钙蛋T、血清肌酸激酶同工酶、血肌酐无统计学差异。13例（41.9%）在IVUS指导下进行,患者术前、术后管腔最小直径、最小直径狭窄率、管腔有效面积有显著差异,分别为2.0±0.3　mm比3.6±0.8　mm、74.5%±6.8%比20.3%±12.5%、4.0±1.4　mm²比　10.7±5.5　mm²（P＝0.000）,平均随访10.4±6.4个月,随访期间无心绞痛、急性心肌梗死、心源性猝死、靶血管再次血运重建事件发生。结论　冠状动脉内旋磨术联合药物洗脱支架治疗严重钙化病变可以去除或减轻钙化斑块、增大管腔,最终提高严重钙化病变介入治疗的成功率。     

冠状动脉严重钙化病变旋磨术后植入药物洗脱长支架的长期临床疗效观察

目的 探讨冠状动脉（简称“冠脉”）旋磨术联合药物洗脱长支架用于治疗严重冠脉钙化病变的安全性及有效性。方法 入选2010年1月至12月因严重冠脉钙化而行冠脉旋磨术联合药物洗脱长支架植入治疗的患者。观察患者的手术成功率,围术期并发症及术后主要心血管事件（包括心源性死亡、心肌梗死、靶病变血运重建）的发生率。结果 共21例严重冠脉钙化病变患者接受了冠脉旋磨术联合药物洗脱长支架植入治疗,年龄（65.2±6.9）岁。合并高血压病16例（76.2%）,糖尿病7例（33.3%）,肾功能不全1例（4.8%）。旋磨部位共植入35枚国产药物支架（1.75枚/部位）,最短支架长度为28mm,病变部位平均支架总长度为48（29～66）mm,仅1例因旋磨头未能通过病变而放弃,手术成功率为95.2%（20/21）。术中1例出现冠脉痉挛,1例出现胸痛伴心率减慢;术后1例出现消化道出血。住院期间无心血管事件发生,平均随访26个月,仅1例（4.8%）患者于术后第2个月发生急性心肌梗死,余患者病情稳定。结论 冠脉旋磨术联合药物洗脱长支架植入术治疗严重冠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。     

冠状动脉旋磨术联合球囊成形术和支架置入术治疗老年人冠状动脉钙化病变26例分析

一、对象与方法　　 1999年 4月至 2 0 0 2年 2月住院的老年冠心病患者 2 6例 ,男性 17例 ,女 9例 ,年龄 6 0～ 78岁 ,平均 (6 5 2± 2 9)岁。 12例为稳定性心绞痛 ,14例为不稳定性心绞痛。共 2 8处靶血管病变 ,前降支 16处 ,回旋支 5处 ,右冠脉 6处 ,左主干 1处。冠状动脉造影证实血栓存在、无保护左主干病变、严重弥漫性 3支病变、慢性阻塞性病变除外。　　用Judkins法行冠状动脉造影 ,血管直径减少≥ 70 %者行冠状动脉介入治疗。再狭窄 :成功扩张的血管随访造影时原处重新狭窄增加≥ 5 0 %。钙化病变的诊断 :冠状动脉钙化可在透视时看…     

冠状动脉旋磨术联和低压球囊成形术治疗冠状动脉钙化病变

目的 :通过联合应用冠状动脉旋磨术及低压球囊成形术对冠状动脉钙化病变患者进行治疗 ,探讨其对治疗钙化病变的安全性及有效性。方法 :对冠状动脉造影证实冠心病患者 2 6例共 2 8处钙化病变行冠状动脉旋磨术 ,并辅以低压冠状动脉球囊成形术 ,观察其手术成功率 ,术后随访 12个月。结果 :冠状动脉旋磨术的手术成功率为 92 8% ,管腔狭窄由术前的 88%± 9%减少至 45 %± 10 %。有 2 5处钙化病变需补充性经皮冠状动脉腔内成形术 (PTCA) (88 3 % ) ,有 3处因旋磨术后残余狭窄 <3 0 %而未行补充治疗。包括补救性治疗在内经皮冠状动脉内旋磨术 (CRA)手术成功率为 10 0 %。术中无主要并发症发生 (包括死亡、Q波心肌梗死、急症冠状动脉搭桥术 ) ,有 3例术中出现血管痉挛 ,术后 72h内有 1例病人出现心肌酶学升高 ,符合无Q波心肌梗死。所有病人平均随访 (10 4± 7 6)个月 ,有 11例心绞痛复发或蹬车试验阳性 ,无心肌梗死和死亡病例。 5例病人行重复冠状动脉造影 ,均为再狭窄。结论 :旋磨术联合低压球囊扩张虽然可取得很高的即刻成功率 ,是治疗钙化病变安全、有效的方法。但其术后再狭窄率仍然较高 ,其确切效果需临床实验结果进一步证实     

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。     

冠状动脉钙化及旋磨术研究进展

冠状动脉粥样硬化性心脏病（Coronary artery disease,CAD）是一种高发病率、起病隐匿的疾病。冠状动脉造影作为诊断冠心病的金标准,对于血管管腔的狭窄程度较敏感,却不能反映出动脉粥样硬化斑块的性质。冠状动脉钙化（Coronaly arterycalcium,CAC）和动脉粥样硬化之间仔在着密切关系。病理研究证实钙化现象仅发生于血管粥样硬化的病变处,并且贯穿于整个动脉粥样硬化病理过程。通过检验并量化冠状动脉的钙化病变,能够早期诊断并预防冠心病的发生。     

冠状动脉旋磨术在老年人冠状动脉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老年人冠状动脉钙化病变的有效性及安全性。方法对32例冠心病患者的钙化病变进行冠脉内旋磨术、冠脉球囊扩张及冠脉支架术,观察患者的冠脉钙化病变改变、手术成功率、围术期并发症及临床随访结果。结果 32例冠状动脉钙化病变患者的33处钙化病变处接受冠状动脉旋磨术治疗,手术成功率为96.88%,结合经皮冠状动脉介入治疗(PCI)共植入74枚支架。围术期无急性心肌梗死、心源性死亡、冠脉穿孔、出血及急诊冠脉旁路移植术(CABG)等并发症。1例发生心脏停搏,1例发生心室颤动,经相应药物等治疗后均恢复窦性心律。对患者进行12个月的随访,无1例再发心绞痛,无1例发生主要心血管事件。结论冠状动脉旋磨术联合PCI术治疗老年人的冠状动脉钙化病变安全、有效。     

Comparison of rotational atherectomy and modified balloons prior to drug-eluting stent implantation for the treatment of heavily calcified coronary lesions

The optimal strategy for lesion preparation in heavily calcified coronary lesions (HCCL) prior to drug-eluting stent (DES) implantation remains debatable. This study sought to compare the performance of rotational atherectomy (RA) and modified balloon (MB)-based strategy in patients with HCCL receiving current-generation DES.This retrospective study comprised 564 consecutive patients who underwent RA (n = 229) or MB (n = 335) for HCCL at our hospital and were treated with DES. Baseline clinical and angiographic data was obtained from our database. Patients were clinically monitored for the occurrence of any adverse events during the hospitalization. One-year follow-up was conducted by either telephone contact or outpatient visits. 1:1 propensity score matching (PSM) was performed to balance the baseline covariates. After PSM, the clinical outcomes between the 2 groups were compared.After PSM, except more target lesion in right coronary artery existing in the RA group (P = .008), no significant statistical differences were shown in regard of the other angiographic and procedural characteristics of the 2 groups. Strategy success rates were all 100% in both groups. In the unadjusted Cox proportional hazard analysis, participants with RA had a significantly lower risk of target lesion revascularization (TLR) (hazard ratio, HR 0.275, 95% confidence intervals, CI 0.119–0.635, P = .003) and major adverse cardiac event (MACE) (HR 0.488, 95% 0.277–0.859, P = .013). After adjusting for potential confounding variables, RA was significantly associated with TLR (HR 0.32, 95% 0.12–0.853, P = .023), but no longer significantly associated with MACE (HR 0.674, 95% 0.329–1.381, P = .282).In patients with HCCL, lesion preparation with RA was safe and could improve strategy success rate. There was lower rate of TLR with RA, however, no significant difference was found in the MACE rate at 1-year follow-up between RA and MB-based strategy.     

Rotational coronary atherectomy with adjunctive balloon angioplasty for the treatment of ostial lesions

Conventional balloon angioplasty (PTCA) of ostial lesions (OL) is associated with suboptimal results and a higher complication rate. Partial plaque ablation with rotational atherectomy (RA) before PTCA might improve results. This approach was used in 63 patients (pts) (mean age 64±10 yrs; 44 men, 19 women) with 69 OL. There were 15 aorto-OL and 54 branch-OL. Calcification was more frequent in aorto-OL than in branch-OL (67% vs. 35%, P< 0.05). Mean burr size was 1.8±0.3 mm. Burr-artery ratio was 0.74±0.10. Adjunctive PTCA was systematically performed. Procedural success was achieved in 58 pts (92%): 14 aorto-OL (93%) and 50 branch-OL (93%) were successfully treated; major complications occurred in 1 (7%) aorto-OL and 1 (2%) branch-OL. Uncomplicated failure occurred in three cases. Minimal lumen diameter (MLD) increased from 0.69±0.31 mm before RA to 1.43±0.28 mm after RA (P<0.001) and 2.16±0.29 mm after PTCA (P<0.001). Diameter stenosis (DS) decreased from 75±13% before RA to 32±12% after RA (P<0.001) and 14±10% after PTCA (P<0.001). All successfully treated pts underwent repeat angiography 24 h later and exercise testing or repeat cardiac catheterization >6 mo later. At 24 h repeat angiography, DS was 17±15% (P=NS vs. after PTCA); no lesion had a DS ≥ 50%. Follow-up coronary angiography was performed in 30 pts (52%) who had abnormal stress testing: 13 pts (43%) showed angiographic restenosis in at least one successfully treated OL. In conclusion, RA with adjunctive PTCA is a safe and effective treatment of OL. It is associated with higher success and lower major complications rates when compared with conventional PTCA. Restenosis remains a major limitation of all percutaneous approaches. © Wiley-Liss, Inc.     

冠状动脉腔内旋磨术联合药物洗脱支架治疗极度严重钙化病变的短中期疗效

目的: 评价冠状动脉腔内旋磨术联合药物洗脱支架术治疗极度严重钙化病变的短中期疗效。方法: 对12例极度严重钙化病变常规经皮冠脉介入治疗(PCI)失败或预期不能实施的冠心病患者实施冠脉内旋磨并植入药物洗脱支架,观察其治疗的即刻疗效及6个月的随访结果。结果: 冠脉内旋磨术的12例患者,其中8例常规PCI治疗失败:2例球囊无法通过病变,3例球囊不能扩张,3例球囊扩张后支架无法通过;4例极度严重钙化预期不能实施常规PCI治疗,12例患者均成功实施冠脉内旋磨术,3例新发生夹层形成,3例出现慢血流,旋磨后11例以低压［小于6 atm(1 atm=101.325 kPa)］充分扩张病变,仅1例需高压（28 atm）扩张病变, 1例在术中发生心原性休克,植入主动脉内球囊反博(IABP)后完成手术;无1例发生冠脉穿孔、死亡、急性心肌梗死及急诊冠脉旁路移植术(CABG),所有病例支架均顺利通过病变并 实施扩张术。对12例患者进行了术后6个月的冠脉造影随访,有1例发生支架内再狭窄。结论: 对常规介入治疗失败或预期难以实施常规介入治疗的极度严重钙化病变,冠脉内旋磨预处理后均能完成支架植入术,旋磨后植入药物洗脱支架短中期疗效良好。     

旋磨术联合切割球囊成形术治疗冠状动脉重度钙化病变

目的血管内超声评价旋磨术联合切割球囊成形术治疗冠状动脉重度钙化病变的安全性及有效性。方法收集冠状动脉造影及血管内超声检查确认至少1处病变为高度钙化,并行旋磨术处理的冠心病患者80例,根据是否使用切割球囊分为单纯旋磨组34例和旋磨联合切割组46例。患者在支架置入前及置入后均行血管内超声检查,评价支架置入效果。结果单纯旋磨组与旋磨联合切割组最大钙化弧度分别为(215.88±21.81)°vs(226.55±21.59)°,钙化长度比为(0.72±0.06)vs(0.78±0.05),支架置入前最小管腔面积为(2.52±0.07)mm2 vs(2.46±0.09)mm2,2组比较差异无统计学意义(P>0.05)。支架置入后,旋磨联合切割组最小支架面积(6.12±0.37)mm2和即刻管腔获得面积(3.66±0.34)mm2,单纯旋磨组分别为(5.42±0.24)mm2和(2.90±0.24)mm2,2组比较差异有统计学意义(P=0.016)。2组术中并发症的发生比例比较,差异无统计学意义(P>0.05)。结论在冠状动脉重度钙化病变中,使用旋磨术联合切割球囊成形术可以获得更好的支架置入后效果。     

Safety and feasibility of orbital atherectomy for the treatment of calcified coronary lesions

Objective: The ORBIT I trial evaluated the safety and performance of an orbital atherectomy system (OAS) for the treatment of de novo calcified coronary lesions. Background: Severely calcified coronary arteries pose an ongoing treatment challenge. Stent placement in calcified lesions can result in stent under expansion, malapposition, and procedural complications. OAS treatment may change calcified lesion compliance to reduce procedural complications and facilitate stent placement. Methods: The ORBIT I trial, a prospective, nonrandomized study, was conducted in two centers in India. Fifty patients with de novo calcified coronary lesions were enrolled. Patients were treated with the OAS followed by stent placement. Results: The average age of the patients was 57.4 years and 90% were male. Mean lesion length was 13.4 mm. The average number of OAS devices used per patient was 1.3. Device success was 98%, and procedural success was 94%. The cumulative major adverse cardiac event rate was 4% in‐hospital (two non–Q‐wave myocardial infarctions), 6% at 30 days (one additional non–Q‐wave myocardial infarction leading to target lesion revascularization), and 8% at 6 months (one additional event of cardiac death). Angiographic complications were observed in seven patients (six dissections and one perforation). Conclusion: The ORBIT I trial suggests that the OAS may offer an effective method to change compliance of calcified coronary lesions to facilitate optimal stent placement in these difficult to treat patients. A larger trial is required to establish safety and overall effectiveness of the OAS in treating calcified coronary lesions. © 2012 Wiley Periodicals, Inc.