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

Rotational atherectomy and percutaneous transluminal coronary angioplasty in complex coronary artery lesions

Objective To determine the clinical effectiveness of rotational atherectomy and percutaneous transluminal coronary angioplasty(PTCA) in complex coronary artery lesions.Some of them were introduced by intravascular ultrasound. Methods 20 lesions in 15 patients were treated with rotational atherectomy and PTCA .We evaluated the successful rate and the complications. Results The burr was successfully achieved to the all lesions.The mean diameter stenosis was decreased from 88.3%±7.54% to 15.6%±10.75%.All cases were treated with PTCA complicatedly and stents were perfomed in 12 patients. One patient had severe coronary vasospasm and 2 were dissection (type B).The slowflow was in 3.8% case . Nobody needed emergence bypass graft surgery and was death. Conclusion Rotational atherectomy and PTCA can be performed in selected complex coronary lesions efficiently and safely.