Benezet Javier, Díaz de la Llera Luis Salvador, Cubero Jose María, Villa Manuel, Fernández-Quero Mónica, Sánchez-González Angel
Department of Cardiology, Hospital Universitario Virgen del Rocio, Avenida Manuel Siurot s/n, 41013 Seville, Spain.
J Invasive Cardiol. 2011 Jan;23(1):28-32.
Rotational atherectomy followed by drug-eluting stent (DES) implantation for complex, severely calcified lesions is a rational combination that has not been sufficiently evaluated.
We investigated 102 consecutive patients with angiographic evidence of heavily calcified lesions that underwent DES implantation following rotational atherectomy at our institution between June 2005 and October 2009, and we examined the long-term clinical outcomes. The major adverse cardiac events monitored were death, myocardial infarction and target lesion revascularization.
Patients were 68.8 ± 7.4 years old, 52.9% were diabetic, and 12.7% had chronic kidney disease. Forty-seven patients (46.1%) had three-vessel disease, and 13 (12.7%) had left main coronary artery stenosis. The radial approach was used in 37.3% of cases. The procedure was successful in 97%. In-hospital death occurred in 1 patient (0.9%), and 3 patients (2.9%) developed stent thrombosis. At the mean follow-up period of 15 months (range 1- 54), the total cardiac death rate was 4.9%, target lesion revascularization was 8.8% and the incidence of myocardial infarction was 3.9%. The combined endpoint occurred in 12.7% of cases.
DES following rotational atherectomy for heavily calcified coronary lesions is a safe and effective procedure that provides good long-term clinical outcomes.
对于复杂、严重钙化病变，先进行旋磨术再植入药物洗脱支架（DES）是一种合理的联合治疗方式，但尚未得到充分评估。
我们调查了2005年6月至2009年10月期间在我院接受旋磨术后植入DES的102例有严重钙化病变血管造影证据的连续患者，并检查其长期临床结局。监测的主要不良心脏事件为死亡、心肌梗死和靶病变血管重建。
患者年龄为68.8±7.4岁，52.9%为糖尿病患者，12.7%患有慢性肾脏病。47例（46.1%）有三支血管病变，13例（12.7%）有左主干冠状动脉狭窄。37.3%的病例采用桡动脉途径。手术成功率为97%。1例患者（0.9%）发生院内死亡，3例患者（2.9%）发生支架血栓形成。在平均15个月（范围1 - 54个月）的随访期内，心脏总死亡率为4.9%，靶病变血管重建率为8.8%，心肌梗死发生率为3.9%。联合终点事件发生率为12.7%。
对于严重钙化的冠状动脉病变，旋磨术后植入DES是一种安全有效的手术，可提供良好的长期临床结局。
