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。     

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。     

血管内超声指导下冠状动脉旋磨术的护理配合

目的探讨血管内超声指导下冠状动脉旋磨术治疗冠状动脉严重钙化病变术中的护理配合,以提高导管室护士的专业护理水平,缩短手术时间,减少术中不良事件的发生。方法通过回顾性分析本中心18例手术患者的临床资料,就术中如何进行良好的护理配合进行讨论总结。结果 18例冠状动脉严重狭窄伴重度钙化病变患者即刻手术成功率100%,1例(5.6%)出现血管痉挛慢血流,2例(11.1%)出现心率、血压下降,给予对症处理后转危为安,无不良事件发生。结论血管内超声指导下冠状动脉旋磨手术难度大,操作复杂,手术时间长,容易出现不同程度的并发症,导管室护士必须具备扎实的专业理论基础、娴熟的操作技术、良好的心理素质,才能更好的配合手术,缩短手术时间,减少不良事件的发生。     

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。     

旋磨与球囊预扩张治疗冠状动脉重度钙化病变的疗效分析

目的研究旋磨与球囊预扩张后植入药物支架对治疗冠状动脉钙化病变的疗效。方法选取接受PCI治疗的冠状动脉重度钙化患者,按随机数字表法分为行旋磨术后支架植入(旋磨组,32例)和球囊预扩张支架植入(对照组,40例),对其进行前瞻性随机对照研究,比较两组治疗特征、围手术期并发症,分析6个月内主要不良心脑血管事件(MACCE)的危险因素。结果旋磨组平均支架直径显著大于对照组[3.25(3.00,3.50)mm比3.00(2.81,3.25)mm,P=0.002]。旋磨组球囊预扩张次数、预扩张最大压力、球囊后扩张次数和后扩张最大压力均显著低于对照组,差异均有统计学意义(P<0.05)。旋磨组术后管腔直径大于对照组[(3.34±0.28)mm比(3.15±0.27)mm,P=0.005]。旋磨组手术即刻成功率(96.9%)大于对照组(92.5%),总MACCE发生率(9.4%)低于对照组(22.5%),但差异无统计学意义(P>0.05)。PCI手术史[危险比(RR)为1.155(95%CI 0.030~0.691,P=0.015)]及球囊预扩张最大压力[危险比(RR)为2.326(95%CI 0.721~0.988,P=0.035)]是6个月内MACCE发生的独立危险因素。结论SYNTAX评分为23~32分的冠状动脉重度钙化病变,旋磨术有提高手术即刻成功率、降低短期不良事件的趋势,PCI手术史、球囊预扩张最大压力是6个月内MACCE发生的独立危险因素。     

血管内超声指导冠状动脉复杂病变的介入治疗进展

冠状动脉造影一直以来不仅是诊断冠心病的金标准,而且也用来指导冠状动脉介入治疗。但冠状动脉造影往往会因为一些客观因素,特别是在复杂的三维解剖学上的平面分辨率有限,术者凭借视觉评估病变的真实面积和长度的可靠性有限,以及在检测钙化方面的敏感性较低等,对术者术中的治疗决策会产生不可避免的误导。而血管内超声可通过提供冠状动脉的断层或横断面图像来指导冠状动脉治疗,目前已成为一种在复杂病变患者中获得更好的支架植入效果的重要方法,与单独的冠状动脉造影相比,具有更好的临床效果。     

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。     

血管内超声指导冠状动脉旋磨对比切割球囊在左主干钙化病变单支架术式中应用1年的随访疗效分析

目的:探讨在血管内超声(IVUS)指导下行冠状动脉(冠脉)旋磨对比切割球囊在左主干钙化病变单支架术式中应用的疗效与安全性,为临床提供参考.方法:回顾性纳入左主干钙化病变行单支架术式的79例患者,按预处理方式分为旋磨组(26例)和切割球囊组(53例).比较两组患者基本资料、病变特点、PCI终点并发症及1年主要心血管不良事...     

冠状动脉旋磨术联合血管内碎石术治疗超高龄严重钙化病变1例

1例87岁女性患者因“发作性胸痛4年,再发半个月”入住中国人民解放军总医院第六医学中心,冠状动脉造影提示左前降支重度狭窄伴钙化。在充分评估病变的基础上,冲击波球囊不能达到病变处,使用Rota-lithotripsy策略治疗,获得满意的治疗效果。     

经桡动脉行冠状动脉斑块旋磨和药物支架置入术治疗严重钙化病变的安全有效性

目的:探讨经桡动脉行冠状动脉斑块旋磨术和药物洗脱支架置入术,治疗严重钙化病变的临床效果。方法:回顾性分析我院2010年1月至2011年1月,经桡动脉行冠状动脉斑块旋磨术和药物洗脱支架置入术,冠心病患者的89例临床资料。并分析其手术特点、并发症及主要不良心血管事件(包括全因死亡、非致死性心肌梗死、靶血管血运重建)。结果:89例(100%)患者均成功经桡动脉行冠状动脉斑块旋磨术,并置入药物洗脱支架。术中共有8例(9.0%)患者发生并发症,经处理后取得良好的效果。术后随访(22.21±4.73)个月,主要不良心血管事件的发生率为12.4%。结论:经桡动脉行冠状动脉斑块旋磨术和药物洗脱支架置入术,治疗严重钙化病变是一种安全、有效的治疗方法。     

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。     

冠状动脉内旋磨术联合支架术治疗严重钙化病变的疗效及随访研究

目的评价冠状动脉(冠脉)内旋磨术联合支架术治疗严重钙化病变的疗效及中期随访结果。方法对21例冠心病患者的严重钙化病变行冠脉内旋磨术及支架术治疗,6例患者在血管内超声的引导下进行,观察其治疗的即刻成功率及6个月的随访结果。结果行冠脉内旋磨术的21例患者,冠脉造影结果均为В2、C型严重钙化病变。旋磨头均成功通过了病变,15例(71.4%)病例仅选择1.25mm的旋磨头,3例(14.3%)病例仅选择1.5mm旋磨头,3例(14.3%)病例使用了2个旋磨头。全部病例均联合应用经皮冠脉血管成形术(PTCA),19例(90.5%)在旋磨术后置入支架。2例(9.5%)在术中发生冠脉痉挛;1例(4.8%)发生无血流现象;无冠脉穿孔、死亡、急性心肌梗死及急诊冠脉旁路移植术(CABG)。对15例患者进行了术后6个月的冠脉造影随访,有2例(13.3%)发生支架内再狭窄。结论冠脉内旋磨术联合支架术治疗严重钙化病变,去除钙化斑块增大管腔,提高了严重钙化病变的经皮冠脉介入治疗(PCI)成功率。     

Safety and effectiveness of percutaneous coronary intervention using rotational atherectomy and new-generation drug-eluting stents for calcified coronary artery lesions in patients with chronic kidney disease

AimCoronary artery calcification is an important factor influencing revascularisation outcomes in patients with chronic kidney disease (CKD). Lesion preparation using rotational atherectomy (RA) may help adequately modify calcified plaques and facilitate the achievement of optimal clinical outcomes in these patients. In this study, we assessed the safety and effectiveness of percutaneous coronary intervention (PCI) using RA followed by new-generation drug-eluting stent (DES) implantation in patients with CKD and calcified coronary artery disease (CAD).Methods and resultsFrom November 2014 to October 2019, a total of 203 patients with calcified CAD who underwent RA followed by second- or third-generation DES implantation at our centre were included in the study. Mild, moderate, and severe CKD was present in 38%, 55.5%, and 6.5% of the patients, respectively. Diffused coronary calcifications were present in 85%. Procedural success was 97.5% with minimal periprocedural complications. In-stent restenosis occurred in one patient (0.5%); major adverse cardiovascular and cerebrovascular events were reported in 22 patients (10.8%); cardiac death occurred in eight patients during follow-up.ConclusionPercutaneous coronary intervention using RA followed by second- or third-generation DES implantation is feasible and safe with high procedural success and low in-stent restenosis in CKD patients with calcified coronary lesions.     

Application of rotational atherectomy in the drug-eluting stent era

Rotational atherectomy (RA) was introduced in the interventional arena in 1988 as a dedicated device for calcified lesions. Due to the complexity of the technique, the development of alternative method...     

Rotablation in the treatment of high-risk patients with heavily calcified left-main coronary lesions

Objective Heavily calcified left-main coronary diseases (LMCA) remain a formidable challenge for percutaneous interventions (PCI). This study was to investigate the safety and efficacy of using rotational atherectomy (RA) in treating such lesions in actual practice. Methods From February 2004 to March 2012, all consecutive patients who received RA for heavily-calcified LMCA lesions in our cath lab were enrolled. The relevant clinical and angiographic characteristics at the time of index PCI, as well as the clinical follow-up outcomes, were retrieved and analyzed. Results A total of 34 consecutive patients were recruited with a mean age 77.2 ± 10.2 years. There were 82.4% presented with acute coronary syndrome and 11.8% with cardiogenic shock. Chronic renal disease and diabetes were seen in 64.7% and 52.9%, respectively. Triple-vessel coronary disease was found in 76.5% of them. The mean SYNTAX score was 50 ± 15 and EuroSCORE II scale 5.6 ± 4.8. The angiographic success rate was 100% with a procedural success rate of 91.2%. The mean number of burrs per patient was 1.7 ± 0.5. Crossing-over stenting was used in 64.7%. Most stents were drug-eluting (67.6%). Intra-aortic ballon pump was used in 20.6% of the procedures. Three patients died during hospitalization, all due to presenting cardiogenic shock. No major complication occurred. Among 31 hospital survivors, the major adverse cardiac events (MACE) rate was 16.1%, all due to target lesion revascularization or target vessel revascularization. Conclusions In high-surgical-risk elderly patients, plaque modification with RA in PCI of heavily-calcified LMCA could be safely accomplished with a minimal complication rate and low out-of-hospital MACE.     

Aggressive plaque modification with rotational atherectomy and cutting balloon for optimal stent expansion in calcified lesions

Objective To evaluate the factors affecting optimal stent expansion in calcified lesions treated by aggressive plaque modification with rotational atherectomy (RA) and a cutting balloon (CB). Methods From January 2014 to May 2015, 92 patients with moderate to severe coronary calcified lesions underwent rotational atherectomy and intravascular ultrasound imaging at Chinese PLA General Hospital (Beijing, China) were included in this study. They were divided into a rotational artherectomy combined with cutting balloon (RACB) group (46 patients treated with RA followed by CB angioplasty) and an RA group (46 patients treated with RA followed by plain balloon angioplasty). Another 40 patients with similar severity of their calcified lesions treated with plain old balloon angioplasty (POBA) were demographically matched to the other groups and defined as the POBA group. All patients received a drug-eluting stent after plaque preparation. Lumen diameter and lumen diameter stenosis (LDS) were measured by quantitative coronary angiography at baseline, after RA, after dilatation, and after stenting. Optimal stent expansion was defined as the final LDS < 10%. Results The initial and post-RA LDS values were similar among the three groups. However, after dilatation, the LDS significantly decreased in the RACB group (from 54.5% ± 8.9% to 36.1% ± 7.1%) but only moderately decreased (from 55.7% ± 7.8% to 46.9% ± 9.4%) in the RA group (time × group, P< 0.001). After stenting, there was a higher rate of optimal stent expansion in the RACB group (71.7% in the RACB group, 54.5% in the RA group, and 15% in the POBA group, P < 0.001), and the final LDS was significantly diminished in the RACB group compared to the other two groups (6.0% ± 2.3%, 10.8% ± 3.3%, 12.7% ± 2.1%, P < 0.001). Moreover, an LDS ≤ 40% after plaque preparation (OR = 2.994, 95% CI: 1.297?6.911) was associated with optimal stent expansion, which also had a positive correlation with the appearance of a calcified ring split (r = 0.581, P < 0.001). Conclusions Aggressive plaque modification with RA and CB achieve more optimal stent expansion. An LDS ≤ 40% after plaque modification was a predictive factor for optimal stent expansion in calcified lesions. This parameter was also associated with the presence of calcified ring split.     

Comparison of frequency and severity of longitudinal stent deformation among various drug-eluting stents: An intravascular ultrasound study

Background

Longitudinal stent deformation (LSD) in drug-eluting stents (DES) has been described as a disruption of stent structure. This study aimed to compare first- versus second-generation DES with respect to their actual stent length post deployment.

Methods

A total of 617 DES for de novo coronary lesions in 552 patients were analyzed. Intravascular ultrasound (IVUS) was utilized to compare the degree and rate of LSD among six different DES types. IVUS-measured stent length was compared to the labeled length for calculation of absolute difference in stent length and relative absolute difference (absolute difference divided by the labeled length).

Results

The baseline characteristics were comparable between groups, except for higher calcification in the sirolimus-eluting stent (SES) group (p = 0.037). The absolute and relative difference in length showed the lowest degree in the SES group and the highest degree in the Endeavor zotarolimus-eluting stent group (p = 0.085 and 0.078, respectively). The percentage of more than 5% relative absolute difference was the lowest in the SES group compared to the other groups (p = 0.018). However, the percentage of significant (> 15%) relative absolute difference was similar among groups (p = 0.99). In multivariate linear regression analysis, labeled stent length and stent diameter, but not stent type, were identified as independent correlates to the absolute and relative difference in the actual stent length post-deployment.

Conclusion

This IVUS analysis confirms that among second-generation DES, there is overall similar frequency and severity of LSD when deploying in common coronary lesions.