Schwartz Bryan G, Mayeda Guy S, Economides Christina, Kloner Robert A, Shavelle David M, Burstein Steven
Heart Institute, Good Samaritan Hospital, 1225 Wilshire Blvd., Los Angeles, CA 90017-2395, USA.
J Invasive Cardiol. 2011 Apr;23(4):133-9.
In heavily calcified lesions, rotational atherectomy (RA) improves procedural success and facilitates stent deployment. Reports on RA in the drug-eluting stent (DES) era are limited. The objective of this study was to determine the presenting characteristics, procedural and in-hospital clinical outcomes of patients who underwent RA at our institution in the DES era.
Consecutive cases involving RA between January 1, 2004 and December 31, 2009 at a private, tertiary referral hospital were reviewed retrospectively.
A total of 158 patients (236 lesions) who underwent RA are described, including 112 patients (158 lesions) with subsequent DES implantation, 19 patients (28 lesions) with bare-metal stent (BMS) implantation, and 27 patients (50 lesions) with no stent. RA was utilized to modify heavily calcified plaque (84%), as bail-out therapy (16%), to preserve the patency of sidebranches (25%) and as debulking therapy for chronic total occlusion (13 lesions) and in-stent restenosis (7 lesions). DES were not placed in 46 patients (23%) due to reference vessel diameter < 2.25 or > 3.75 mm, inability to deliver DES, or desire to avert clopidogrel therapy. Angiographic and procedural success rates were significantly higher in the DES and BMS groups compared with the no stent group (angiographic success: 99.1% for DES versus 95% for BMS versus 63% for no stent; p < 0.05; procedural success: 96.4% for DES versus 95% for BMS versus 63% for no stent; p < 0.05).
In the DES era, RA remains utilized primarily to modify heavily calcified plaque. In unadjusted analysis, procedural success appears high with subsequent stent placement (DES or BMS) versus RA alone. However, 1 in 4 are not candidates for stent placement, and the lower procedural success rate in this population should be considered prior to embarking on RA.
在严重钙化病变中，旋磨术（RA）可提高手术成功率并便于支架置入。药物洗脱支架（DES）时代关于旋磨术的报道有限。本研究的目的是确定在DES时代于我院接受旋磨术患者的临床表现、手术及住院临床结局。
回顾性分析2004年1月1日至2009年12月31日在一家私立三级转诊医院接受旋磨术的连续病例。
共描述了158例行旋磨术的患者（236处病变），其中112例患者（158处病变）随后植入了DES，19例患者（28处病变）植入了裸金属支架（BMS），27例患者（50处病变）未植入支架。旋磨术用于处理严重钙化斑块（84%）、作为补救治疗（16%）、保持分支通畅（25%）以及作为慢性完全闭塞（13处病变）和支架内再狭窄（7处病变）的减容治疗。46例患者（23%）因参考血管直径<2.25或>3.75mm、无法输送DES或希望避免氯吡格雷治疗而未植入DES。与未植入支架组相比，DES组和BMS组的血管造影和手术成功率显著更高（血管造影成功率：DES组为99.1%，BMS组为95%，未植入支架组为63%；p<0.05；手术成功率：DES组为96.4%，BMS组为95%，未植入支架组为63%；p<0.05）。
在DES时代，旋磨术仍主要用于处理严重钙化斑块。在未校正分析中，与单纯旋磨术相比，后续置入支架（DES或BMS）时手术成功率似乎较高。然而，四分之一的患者不适合置入支架，在进行旋磨术前应考虑该人群较低的手术成功率。
