Bertrand M E, Lablanche J M, Leroy F, Bauters C, De Jaegere P, Serruys P W, Meyer J, Dietz U, Erbel R
Division of Cardiology B, Hôpital Cardiologique, University of Lille, France.
Am J Cardiol. 1992 Feb 15;69(5):470-4. doi: 10.1016/0002-9149(92)90988-b.
This study reports the results from 3 European centers using rotary ablation with Rotablator, a device that is inserted into the coronary artery and removes atheroma by grinding it into millions of tiny fragments. Rotary ablation was performed in 129 patients. Primary success (reduction in percent luminal narrowing greater than 20%, residual stenosis less than 50%, without complications) was achieved by rotary angioplasty alone in 73 patients (57%). An additional 38 patients (29%) had successful adjunctive balloon angioplasty. Thus primary success was achieved in 111 patients (86%) at the end of the procedure. Acute occlusion occurred in 10 patients (7.7%). Recanalization was achieved by balloon angioplasty in 7: urgent bypass grafting was undertaken in 2. Q-wave and non-Q-wave myocardial infarction occurred in 3 and 7 patients, respectively. No deaths occurred. Follow-up angiography was performed in 74 patients (60%). Restenosis, defined as the recurrence of significant luminal narrowing (greater than 50%) occurred in 17 of 37 patients (46%) who underwent rotary ablation alone, and 11 of 37 patients (30%) who had adjunctive balloon angioplasty. The overall angiographic restenosis rate was 37.8%. In conclusion, rotary ablation is technically feasible, and relatively safe in the coronary circulation. The low primary success rate reflects the limited size of the device, which can be introduced through available guiding catheters, and limits the use of rotary ablation as a stand-alone procedure to lesions in small arteries or in distal locations. No reduction in restenosis was seen, but the role of this device combined with balloon angioplasty in larger arteries needs to be further defined.
本研究报告了来自3个欧洲中心使用旋磨消融术（Rotablator）的结果。Rotablator是一种插入冠状动脉并通过研磨将动脉粥样硬化斑块磨成数百万微小碎片来清除斑块的设备。对129例患者实施了旋磨消融术。单纯旋磨血管成形术使73例患者（57%）获得了主要成功（管腔狭窄百分比降低超过20%，残余狭窄小于50%，且无并发症）。另外38例患者（29%）辅助球囊血管成形术成功。因此，手术结束时111例患者（86%）获得了主要成功。10例患者（7.7%）发生急性闭塞。7例患者通过球囊血管成形术实现了再通，2例患者进行了紧急搭桥手术。分别有3例和7例患者发生Q波和非Q波心肌梗死。无死亡病例。74例患者（60%）接受了随访血管造影。在单纯接受旋磨消融术的37例患者中，17例（46%）发生再狭窄，定义为管腔显著狭窄（大于50%）复发；在接受辅助球囊血管成形术的37例患者中，11例（30%）发生再狭窄。总体血管造影再狭窄率为37.8%。总之，旋磨消融术在技术上是可行的，在冠状动脉循环中相对安全。较低的主要成功率反映了该设备尺寸有限，只能通过现有的引导导管插入，这限制了旋磨消融术作为独立手术应用于小动脉或远端部位的病变。未观察到再狭窄率降低，但该设备与球囊血管成形术联合应用于较大动脉的作用有待进一步明确。
