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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

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2010年第2期
页码:
200-202
栏目:
临床研究
出版日期:
2010-03-04

文章信息/Info

Title:
Short- to mid-term efficacy of rotational atherectomy with drug-eluting stents in extremely heavily calcified lesions
作者:
李成祥; 王琳; 王海昌; 袁铭; 郭文怡
第四军医大学西京医院心内科，陕西 西安 710032
Author(s):
LI Cheng-xiang;  WANG Lin;  WANG Hai-chang;  YUAN Ming;  GUO Wen-yi
Department of Cardiology, Xijing Hospital, Fourth Military Medical University, Xi’an 710033, Shaanxi, China
关键词:
旋磨; 冠状动脉硬化; 支架; 冠状动脉成形术; 经腔; 经皮
Keywords:
rotational atherectomy;  stents;  coronary angioplasty;  transluminal;  percutaneous
分类号:
R541.4
DOI:
-
文献标识码:
A
摘要:
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。
Abstract:
AIM: To assess the immediate and mid-term outcomes of combining intracoronary artery rotational atherectomy (RA) and drug-eluting stents in the treatment of extremely heavily calcified lesions. METHODS: Twelve patients were treated with RA followed by drug-eluting stents. Among the 12 patients, routine interventional treatment was unsuccessful in eight patients, among which there was failure of balloon penetrating the calcified lesions in two cases, incomplete expansion of the balloon in three cases and failure of stent passage following successful balloon expansion in three cases. The other four patients were not suitable for routine interventional therapy. The therapeutic efficacy of RA followed by drug-eluting stents and a 6-month follow-up were evaluated. RESULTS: All 12 patients were successfully treated with RA followed by stenting procedure. Of the 12 patients, no-flow was observed in three cases, new dissection after PCI was seen in three cases and severe coronary shock occurred in one patient who received IABP. None of the 12 cases was treated with emergency bypass graft surgery and no deaths occurred. During the 6-month follow-up, in-stent restenosis was found in only one case by angiogram. CONCLUSION: Combination of intracoronary artery RA and drug-eluting stents is an effective procedure with good short- to mid-term efficacy for patients with extremely heavily calcified lesions who have failed routine interventional treatment.

参考文献/References

［1］ Baim DS, Levine MJ, Leon MB, et al. Management of restenosis within the Palmaz-Schatz coronary stent the U.S. multicenter experience. The U.S. Palmaz-Schatz Stent Investigators［J］. Am J Cardiol, 1993, 71(4):364-366.

［2］ vom Dahl J, Radke PW, Haager PK, et al. Clinical and angiographic predictors of recurrent restenosis after percutaneous transluminal rotational atherectomy for treatment of diffuse in-stent restenosis［J］. Am J Cardiol, 1999, 83(6):862-867.

［3］ Adamian M, Colombo A, Briguori C, et al. Cutting balloon angioplasty for the treatment of in-stent restenosis:a matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty［J］. J Am Coll Cardiol, 2001, 38(3):672-679.

［4］ Adamian M, Colombo A, Briguori C, et al. Cutting balloon angioplasty for the treatment of in-stent restenosis: a matched comparison with rotational atherectomy, additional stent implantation and balloon angioplasty［J］. J Am Coll Cardiol, 2001, 38(3):672-679.

［5］ Albiero R, Silber S, Di Mario C, et al. Cutting balloon versus conventional balloon angioplasty for the treatment of in-stent restenosis：results of the restenosis cutting balloon evaluation trial(RESCUT)［J］. J Am Coll Cardio1, 2004, 43(6):943-949．

［6］ Whitlow PL, Bass TA, Kippeman RM, et al. Results of the study to determine rotablator and transluminal angioplasty strategy (STRATAS) ［J］. Am J Cardiol, 2001, 87(6):699-705．

［7］ Toutouzas K, Di Mario C, Falotico R, et al. Sirolimus-eluting stents： a review of experimental and clinical findings［J］. Z Kardiol, 2002, 91(Suppl 3):49-57．

［8］ Bossi I, Klersy C, Black AJ, et al. In-stent restenosis：long-term outcome and predictors of subsequent target lesion revascularization after repeat balloon angioplasty［J］. J Am coll Cardiol, 2005, 35(6):1569-1576．

［9］ Haager PK, Schiele F, Buettner HJ, et al. Insufficient tissue ablation by rotational atherectomy leads to worse long-term results in comparison with balloon angioplasty alone for the treatmeats of diffuse instent restenosis: insights from the intravascular ultrasound substudy of the ARTIST randomized multicenter trial［J］. Catheter Cardiovasc Interv, 2003, 60(1):25-31.

备注/Memo

备注/Memo:
收稿日期：2009-1-12.作者简介:李成祥,副教授Email:lichengxiang.2007@yahoo.com.cn 共同第一作者：王琳，主治医师，硕士Email:tianleill@yahoo.com.cn
更新日期/Last Update: 2010-03-05