摘要
目的探讨冠状动脉旋磨术（rotational atherectomy，RA）联合药物洗脱支架（drug eluting stent，DES）植入治疗冠状动脉重度钙化病变的安全性与有效性，分析要点。方法回顾性分析2014年1月至2015年12月行RA联合DES治疗的62例患者（68处病变）的临床资料，分析手术特点、术后疗效、并发症、住院及随访期内主要不良心血管事件发生率。结果62例共使用75个旋磨头，平均（1.18±0.27）个/例，旋磨头直径/靶血管直径为（0.54±0.07） ，RA手术成功率98.4%（61/62）；61例患者共植入支架103枚，平均（1.67±0.55）枚/例，植入支架平均（44.5±11.8） mm，DES术即刻成功率100%。RA术后，靶血管管腔直径（2.33±0.52）mm、靶血管狭窄程度（29.6±4.8）%、心肌梗死溶栓试验Ⅲ级血流比例（66.2%）均较术前显著改善[（0.75±0.21） mm、（82.5±7.2）%、10.3%]（P均〈0.05），DES术后靶血管管腔直径[（3.26±0.43） mm、靶血管狭窄程度（8.7±2.1）%、心肌梗死溶栓试验Ⅲ级血流比例98.5%较RA术后进一步显著改善（P均〈0.05）；联合术后3 d左心室射血分数（60.5±5.5）%显著高于术前水平（56.8±4.7）%（P〈0.05）。介入手术相关并发症发生率9.7%，其中1例旋磨头嵌顿患者改行冠状动脉旁路移植术。住院期间主要不良心血管事件发生率4.8%。术后随访9.0～22.0个月，随访期间不良心血管事件发生率8.2%。结论冠状动脉重度钙化病变旋磨后联合DES植入能进一步改善冠状动脉狭窄与血流，中期疗效安全、可靠；规范RA操作是确保介入治疗成功的关键。
ObjectiveTo investigate the efficacy and safety of rotational atherectomy （RA） combined with drug eluting stent （DES） implantation in the treatment of severe coronary artery calcification, and analyze key operation points.MethodsThe clinical data of sixty-two patients （68 lesions） treated with RA combined with DES from January 2014 to December 2015 were retrospectively analyzed, including the characteristics of operation, postoperative curative effect, complications, incidence of major adverse cardiovascular events （MACE） during hospitalization and follow-up period.ResultsA total of 75 rotary blur were used in the 62 cases, with an average of（1.18±0.27）per case, the blur diameter/target vessel diameter was （0.54±0.07）, the success rate of RA was 98.4% （61/62）; A toal of 103 DES were implanted in 61 patients, with an average of（1.67±0.55）per case, average length was（44.5±11.8） mm, immediate DES success rate was 100%.After RA, target vessel diameter was （2.33±0.52） mm, target vessel narrow degree was （29.6±4.8）%, thrombolysis in myocardial infarction grade Ⅲ blood flow ratio was 66.2%, which have been significantly improved compared with preoperation （（0.75±0.21） mm, （82.5±7.2）%, 10.3%）（P〈0.05）, the target vascular lumen diameter and stenosis of target vessel continued to improve after DES （（3.26±0.43） mm, （8.7±2.1）%, 98.5%） （P〈0.05）; At 3 days after operation, the left ventricular ejection fraction was significantly higher than that before the operation （ （60.5±5.5）% vs.（56.8±4.7）%）（P〈0.05）. The incidence of complications associated with interventional procedures was 9.7%, in which 1 case with burr incarceration switched to coronary artery bypass grafting.The incidence of major adverse cardiovascular events incidence during hospitalization was 4.8%, the follow-up period was 9.0-22.0 months.The incidence of major adverse cardiovascular events incidence during follow-up was 8.2%.ConclusionDES implantation following RA in the treatment of severe coronary artery calcification can further improve blood flow and artery stenosis, medium-term efficacy is safe and reliable; standardized RA operation is the key to ensure the success of interventional therapy.
出处
《中国综合临床》
2018年第1期15-20,共6页
Clinical Medicine of China
基金
国家自然科学基金（81070227）
北京市自然科学基金（7142048）
北京市教育委员会科技计划面上项目（km201110025019）
关键词
冠状动脉钙化病变
冠状动脉旋磨术
药物洗脱支架
并发症
不良心血管事件
Coronary artery calcification
Coronary rotational atherectomy
Drug eluting stent
Complication
Major adverse cardiovascular events
