Kobayashi Y, De Gregorio J, Kobayashi N, Akiyama T, Reimers B, Moussa I, Di Mario C, Finci L, Colombo A
Centro Cuore Columbus, Milan, Italy.
Catheter Cardiovasc Interv. 1999 Apr;46(4):406-14. doi: 10.1002/(SICI)1522-726X(199904)46:4<406::AID-CCD4>3.0.CO;2-Z.
The present study evaluated the acute and follow-up results of stenting following aggressive rotational atherectomy compared with stenting following less aggressive rotational atherectomy. Recent work has demonstrated that stenting following rotational atherectomy is a promising strategy for complex and calcified lesions. However, there is little information available regarding the optimal procedural technique of rotational atherectomy to be employed before stent implantation. Between May 1995 and February 1997, 162 lesions in 126 patients were stented following rotational atherectomy because of the presence of severe calcification on fluoroscopy or intravascular ultrasound (95%). The lesions were divided as to whether aggressive rotational atherectomy was performed or not. Aggressive rotational atherectomy, defined as the use of a final burr size > or =2.25 mm and/or final burr/vessel ratio > or =0.8, was performed in 56 lesions. A less aggressive rotational atherectomy strategy was performed in 106 lesions. Procedural Q-wave (8.9% vs. 1.9%, P<0.05) and non-Q-wave (11% vs. 1.9%, P<0.05) myocardial infarctions were observed more frequently after aggressive rotational atherectomy; there was no significant difference in the incidence of other procedural complications. Although there was no significant difference in minimal lumen diameter after the procedure (3.11+/-0.68 vs. 2.99+/-0.48 mm, NS), at follow-up a greater minimal lumen diameter was observed in the lesions treated with aggressive rotational atherectomy compared to those treated with less aggressive rotational atherectomy (2.12+/-1.31 vs. 1.56+/-0.89 mm, P<0.01). Restenosis rates were 50.0% in the lesions treated without aggressive rotational atherectomy and 30.9% in those treated with aggressive rotational atherectomy (P<0.05). There was no significant difference in the incidence of restenosis with a focal pattern between the two groups (25.0% vs. 21.4%, NS). In contrast, restenosis with a diffuse pattern was lower in lesions treated with aggressive rotational atherectomy than in those without aggressive rotational atherectomy (9.5% vs. 25.0%, P<0.05). Aggressive rotational atherectomy followed by stenting is a promising strategy to reduce the restenosis rate in calcified lesions. However, the aggressive strategy is associated with an increased risk of procedural myocardial infarction.
本研究评估了与采用不太积极的旋磨术后置入支架相比，积极的旋磨术后置入支架的急性和随访结果。近期研究表明，旋磨术后置入支架对于复杂和钙化病变是一种有前景的策略。然而，关于在支架植入前采用的旋磨术最佳操作技术，几乎没有可用信息。1995年5月至1997年2月期间，126例患者的162处病变因透视或血管内超声显示严重钙化（95%）而在旋磨术后置入支架。根据是否进行积极的旋磨术对病变进行分组。56处病变采用了积极的旋磨术，定义为使用最终磨头尺寸≥2.25mm和/或最终磨头/血管直径比≥0.8。106处病变采用了不太积极的旋磨术策略。积极的旋磨术后更频繁地观察到手术相关的Q波心肌梗死（8.9%对1.9%，P<0.05）和非Q波心肌梗死（11%对1.9%，P<0.05）；其他手术并发症的发生率无显著差异。尽管术后最小管腔直径无显著差异（3.11±0.68对2.99±0.48mm，无统计学意义），但随访时与采用不太积极的旋磨术治疗的病变相比，采用积极的旋磨术治疗的病变观察到更大的最小管腔直径（2.12±1.31对1.56±0.89mm，P<0.01）。未采用积极的旋磨术治疗的病变再狭窄率为50.0%，采用积极的旋磨术治疗的病变再狭窄率为30.9%（P<0.05）。两组间局灶性再狭窄的发生率无显著差异（25.0%对21.4%，无统计学意义）。相比之下，采用积极的旋磨术治疗的病变弥漫性再狭窄低于未采用积极的旋磨术治疗的病变（9.5%对25.0%，P<0.05）。积极的旋磨术后置入支架是降低钙化病变再狭窄率的一种有前景的策略。然而，这种积极的策略与手术相关心肌梗死风险增加有关。
