Seca Luís, Cação Romeu, Silva Joana, Mota Paula, Costa Marco, Leitão Marques António
Centro Hospitalar de Coimbra, EPE, Coimbra, Portugal.
Rev Port Cardiol. 2012 Jan;31(1):1-6. doi: 10.1016/j.repc.2011.09.015. Epub 2011 Dec 6.
Percutaneous coronary intervention (PCI) of heavily calcified lesions is a challenge for the interventional cardiologist and is associated with a high rate of restenosis and target lesion revascularization (TLR). Adequate lesion preparation by rotational atherectomy followed by drug-eluting stent implantation has shown favorable results.
To report the recent experience of our center with rotational atherectomy (RA) of complex and heavily calcified coronary lesions.
We retrospectively analyzed consecutive patients who underwent PCI with RA in our center between January 2009 and December 2010. A total of 42 patients were included, 65% of whom had been previously refused for coronary artery bypass grafting due to unfavorable coronary anatomy or high surgical risk. RA was performed using the standard Boston Scientific Rotablator(®) system. The procedure was performed ad-hoc in 50% of patients and transradial access was used in 35%. Data were collected on immediate post-procedural events and major cardiac events during follow-up - cardiovascular death, myocardial infarction, TLR and recurrent angina.
Of 1650 PCIs performed in a 23-month period from January 2009, 42 (2.5%) involved RA, a total of 42 patients (mean age 70.3±10.1 years, 67% male, 55% diabetic), three of whom had left main disease, six had three-vessel disease, 18 had two-vessel disease and the other 15 had single-vessel disease. Of the lesions treated, 71% were >20 mm long and classified in 69% of cases as type C according to the ACC/AHA lesion classification, 4% being chronic total occlusions. The left anterior descending artery was treated in 56% of the procedures. The mean number of burrs used per lesion was 1.3 and a total of 69 stents were implanted, 81% of which were drug-eluting. During follow-up three patients had recurrent angina, one required TLR and two died due to a cardiovascular event. There was significant clinical improvement in 83% of patients.
This study demonstrates that rotational atherectomy followed by stenting in heavily calcified lesions can nowadays be performed with high success rates and few complications, extending the possibility of coronary revascularization to a greater number of patients.
严重钙化病变的经皮冠状动脉介入治疗（PCI）对介入心脏病专家来说是一项挑战，且与再狭窄和靶病变血运重建（TLR）的高发生率相关。通过旋磨术进行充分的病变预处理，随后植入药物洗脱支架已显示出良好的效果。
报告我们中心近期采用旋磨术（RA）治疗复杂和严重钙化冠状动脉病变的经验。
我们回顾性分析了2009年1月至2010年12月期间在我们中心接受RA-PCI治疗的连续患者。共纳入42例患者，其中65%因冠状动脉解剖结构不佳或手术风险高而先前被拒绝行冠状动脉旁路移植术。使用标准的波士顿科学Rotablator®系统进行旋磨术。50%的患者采用临时手术方式，35%采用经桡动脉入路。收集术后即刻事件及随访期间主要心脏事件的数据——心血管死亡、心肌梗死、TLR和复发性心绞痛。
在2009年1月起的23个月期间进行的1650例PCI中，42例（2.5%）涉及RA，共42例患者（平均年龄70.3±10.1岁，67%为男性，55%为糖尿病患者），其中3例患有左主干病变，6例患有三支血管病变，18例患有两支血管病变，其余15例患有单支血管病变。在治疗的病变中，71%长度>20 mm，根据ACC/AHA病变分类，69%的病例为C型，4%为慢性完全闭塞。56%的手术治疗左前降支。每个病变平均使用的磨头数量为1.3个，共植入69枚支架，其中81%为药物洗脱支架。随访期间，3例患者出现复发性心绞痛，1例需要TLR，2例因心血管事件死亡。83%的患者有显著的临床改善。
本研究表明，如今在严重钙化病变中先进行旋磨术再置入支架可获得高成功率且并发症少，从而将冠状动脉血运重建的可能性扩大到更多患者。
