Department of Cardiovascular Center Medicine, Toranomon Hospital, Tokyo, Japan.
J Cardiol. 2010 Mar;55(2):232-7. doi: 10.1016/j.jjcc.2009.11.003. Epub 2009 Dec 10.
Drug-eluting stents (DES) have significantly reduced in-stent restenosis. But the calcification of coronary artery lesions in hemodialysis patients is a high-risk factor for restenosis after DES implantation. We hypothesized that percutaneous transluminal coronary rotational atherectomy (PTCRA) may be useful in the prevention of underexpansion and fracture of the stents, thereby reducing major adverse cardiac events.
We retrospectively compared the primary success and mid-term outcomes (major adverse cardiac events within 12 months) of hemodialysis patients with calcified coronary lesions undergoing DES implantation using PTCRA (n=26) with those where DES was implanted without PTCRA (n=28).
The rates of target lesion revascularization in the PTCRA group were lower than those in the non-PTCRA group (11.5% vs 35.7%, p=0.026). The rates of restenosis and subacute thrombosis in the PTCRA group were modestly lower than those in the non-PTCRA group (restenosis rate, 17.4% vs 17.4%, p=0.061; subacute thrombosis rate, 0% vs 7.1%, p=0.31).
PTCRA may be useful for improving the mid-term outcome of DES implantation in hemodialysis patients with calcified lesions.
药物洗脱支架（DES）显著降低了支架内再狭窄率。但血液透析患者冠状动脉病变的钙化是 DES 植入后再狭窄的高危因素。我们假设经皮冠状动脉腔内旋磨术（PTCRA）可能有助于预防支架扩张不足和支架断裂，从而降低主要不良心脏事件的发生风险。
我们回顾性比较了接受 DES 植入的伴有钙化性冠状动脉病变的血液透析患者，其中 26 例采用 PTCRA，28 例未采用 PTCRA，比较两组患者的即刻成功率和中期结果（12 个月内主要不良心脏事件）。
PTCRA 组的靶病变血运重建率低于非 PTCRA 组（11.5% vs. 35.7%，p=0.026）。PTCRA 组的再狭窄率和亚急性血栓形成率略低于非 PTCRA 组（再狭窄率，17.4% vs. 17.4%，p=0.061；亚急性血栓形成率，0% vs. 7.1%，p=0.31）。
对于伴有钙化病变的血液透析患者，PTCRA 可能有助于改善 DES 植入的中期结果。
