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目的探讨在药物支架时代冠状动脉旋磨术治疗冠状动脉钙化病变的安全性及有效性。方法连续收集自2008年3月1日至2011年12月31日的本院单中心63例行冠状动脉旋磨术的患者资料,并回顾分析临床资料,手术成功率及临床效果和主要心血管事件(心源性死亡、心肌梗死和靶病变重建)的发生率。结果 63例患者共有66处钙化病变,63例患者中5例为急性心肌梗死(7.9%);58例为不稳定型心绞痛(92.1%)。17例(27%)合并糖尿病,52例(82.5%)合并高血压。66处病变中60处(90.9%)旋磨联合球囊扩张及DES支架植入,4处(6.1%)旋磨加球囊扩张未植入支架,2处(3.0%)仅旋磨,未植入DES支架是由于血管直径<2.25 mm。手术成功率为96.8%。1例残余狭窄大于50%,另1例左主干患者术后12小时心源性死亡,考虑为可能性支架血栓形成。所有患者随访8～12个月。有2例再发心绞痛,无主要心血管事件(包括心源性死亡、心肌梗死、靶病变血运重建)发生。结论在药物支架时代,冠状动脉旋磨术联合球囊扩张和支架植入术治疗冠状动脉钙化病变是治疗钙化病变安全、有效的方法,可取得很高的手术成功率。
Objective To investigate the safety and efficacy of coronary atherectomy in the treatment of coronary artery calcification in the era of drug-eluting stent. Methods The data of 63 patients who underwent coronary atherectomy were collected continuously from March 1, 2008 to December 31, 2011. The clinical data, operative success rate, clinical effect and major cardiovascular Incidence of cardiac events (cardiac death, myocardial infarction, and target lesion reconstruction). Results A total of 66 calcifications were found in 63 patients, 5 of 63 patients with acute myocardial infarction (7.9%) and 58 patients with unstable angina (92.1%). 17 cases (27%) with diabetes, 52 cases (82.5%) with hypertension. At 66 lesions (90.9%), rotational atherectomy combined with balloon dilatation and DES stent implantation, 4 (6.1%) rotational atherectomy and balloon dilatation were not implanted in the stent, 2 (3.0% DES stent implantation is due to the vessel diameter <2.25 mm. Surgical success rate was 96.8%. One case had a residual stenosis greater than 50% and the other left main patient died of cardiogenic disease 12 hours after the procedure, considering the possibility of stent thrombosis. All patients were followed up for 8 to 12 months. There were 2 recurrent angina and no major cardiovascular events (including cardiogenic death, myocardial infarction, target lesion revascularization) occurred. Conclusion In the era of drug-eluting stent, coronavirus rotational atherectomy combined with balloon dilatation and stent implantation for the treatment of calcification of coronary artery is a safe and effective method for the treatment of calcified lesions, which can achieve a high success rate of surgery.