Pedersen Wesley R, Goldenberg Irvin F, Johnson Randall K, Mooney Michael R
Abbott Northwestern Hospital and Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
Catheter Cardiovasc Interv. 2003 Jul;59(3):329-32. doi: 10.1002/ccd.10552.
We describe a case of rotational atherectomy (RA) used in the setting of extensive coronary dissection. Unsuccessful predilitation of a heavily calcified proximal LAD stenosis resulted in balloon rupture, which produced occlusive dissection extending into the mid LAD. Limited options for this patient required that we perform RA to permit stent delivery and deployment and avoid anterior myocardial infarction. A brief discussion of reasons for balloon angioplasty failure and the potential role for subsequent RA is given. Predictors for coronary perforation when performing RA are reviewed. Our rationale and strategy to avoid the increased risk of perforation with RA in this contraindicated setting of extensive dissection is given.
我们描述了一例在广泛冠状动脉夹层情况下使用旋磨术（RA）的病例。对严重钙化的左前降支近端狭窄进行预扩张未成功，导致球囊破裂，进而产生闭塞性夹层并延伸至左前降支中段。该患者的选择有限，这要求我们进行旋磨术以允许支架输送和置入，避免前壁心肌梗死。文中简要讨论了球囊血管成形术失败的原因以及后续旋磨术的潜在作用。回顾了进行旋磨术时冠状动脉穿孔的预测因素。给出了我们在这种广泛夹层的禁忌情况下避免旋磨术导致穿孔风险增加的基本原理和策略。
