Ito Hiroki, Piel Sheri, Das Pranab, Chhokar Vikram, Khadim Ghazanfar, Nierzwicki Robert, Williams Alexis, Dieter Robert S, Leya Fred
Division of Cardiology, Loyola University Medical Center, EMS Building 6th Floor, 2160 S. First Avenue, Maywood, IL 60153, USA.
J Invasive Cardiol. 2009 Nov;21(11):598-601.
The prognosis after rotational atherectomy of a side-branch ostium to treat bifurcation coronary lesions is unknown.
This was a retrospective case-review study of 40 consecutive patients who underwent rotational atherectomy of the sidebranch ostium to treat symptomatic bifurcation coronary lesions meeting the Medina classification (1,1,1) at our institution between 2003 and 2007.
Twenty-two (55.0%) patients underwent rotational atherectomy of the side-branch ostium alone and 18 (45.0%) underwent rotational atherectomy of the both the main vessel and the sidebranch ostium. Most of the patients (n = 37, 92.5%) had a drug-eluting stent placed in the main vessel after rotational atherectomy. Only 8 patients (20.0%) required side-branch stents, and 2 patients (5.0%) underwent a final kissing-balloon technique. No acute closure of the side branch or coronary perforation were observed. Major adverse cardiac events included cardiac death (n = 1; 2.5%), nonfatal myocardial infarction (n = 1; 2.5%), target vessel revascularization (n = 2; 5.0%) and target lesion revascularization (n = 0; 0.0%) during the mean follow-up period of 21.3 +/- 18.5 months.
The study demonstrated safety and feasibility of rotational atherectomy and provisional side-branch stenting to treat side-branch ostial lesions of true severe bifurcation coronary artery disease. The study results suggest that rotational atherectomy of a side-branch ostium prior to main-vessel stenting may be an option in selected patients undergoing complex bifurcation lesion angioplasty.
应用旋磨术处理分支开口以治疗冠状动脉分叉病变后的预后尚不清楚。
这是一项回顾性病例研究，连续纳入了2003年至2007年间在我院接受旋磨术处理分支开口以治疗符合Medina分型（1,1,1）的有症状冠状动脉分叉病变的40例患者。
22例（55.0%）患者仅接受了分支开口旋磨术，18例（45.0%）患者接受了主支血管和分支开口旋磨术。大多数患者（n = 37，92.5%）在旋磨术后于主支血管置入了药物洗脱支架。仅8例患者（20.0%）需要分支支架置入，2例患者（5.0%）接受了最终的球囊对吻技术。未观察到分支急性闭塞或冠状动脉穿孔。在平均21.3±18.5个月的随访期内，主要不良心脏事件包括心源性死亡（n = 1；2.5%）、非致死性心肌梗死（n = 1；2.5%）、靶血管血运重建（n = 2；5.0%）和靶病变血运重建（n = 0；0.0%）。
本研究证明了旋磨术及临时分支支架置入治疗真正严重冠状动脉分叉病变分支开口病变的安全性和可行性。研究结果提示，对于接受复杂分叉病变血管成形术的特定患者，在主支血管支架置入前进行分支开口旋磨术可能是一种选择。
