Kato Ryuichi, Ashikaga Takashi, Sakurai Kaoru, Ito Junko, Ogawa Toru, Tahara Takanori, Yokoyama Yasuhiro, Satoh Yasuhiro
National Hospital Organization, Disaster Medical Center, 3256 Midori, Tachikawa, Tokyo, 190-0042, Japan.
Cardiovasc Interv Ther. 2012 Sep;27(3):155-60. doi: 10.1007/s12928-012-0102-7. Epub 2012 Apr 5.
Calcified lesions have been known as a cause of stent underexpansion which increases the risk of thrombosis and in-stent restenosis. A dual wire balloon has been introduced to create a focal stress pattern in a localized region of the calcification. We evaluated the combination therapy using a dual wire balloon after rotational atherectomy (RA) for heavily calcified lesions. Of 21 consecutive patients with severe calcified lesions, 10 patients were treated with a dual wire balloon after RA, and 11 patients were treated with RA alone or, RA plus the conventional balloon. Finally, drugeluting stents (DES) were implanted in all cases. Baseline characteristics, lesion characteristics, and postdilatation procedures were not different between two groups. Before implantation of DES, a dual wire balloon enabled adequate dilatation with significantly more cracks than RA (1.8 ± 0.4 cracks vs. 1.2 ± 0.6 cracks, P = 0.02). The minimal stent cross sectional area (CSA) and the stent expansion ratio were similar in both groups. However, the symmetrical expansion was significantly accomplished in patients with a dual wire balloon compared to those without it (mean ratio calculated by dividing the shortest diameter by the longest diameter at the site of the minimal stent CSA was 0.83 ± 0.05 vs. 0.76 ± 0.07, P = 0.02). Moreover, no in-stent restenosis was observed in patients treated with a dual wire balloon at follow-up. In conclusion, by using a dual wire balloon after RA, adequate stent expansion and follow-up results were accomplished. This combination therapy is safety and feasible procedure for the treatment of severe calcified lesions.
钙化病变一直被认为是支架扩张不足的一个原因，这会增加血栓形成和支架内再狭窄的风险。一种双丝球囊已被引入，以在钙化的局部区域形成局部应力模式。我们评估了在旋磨术（RA）治疗严重钙化病变后使用双丝球囊的联合治疗方法。在连续21例严重钙化病变患者中，10例患者在RA后接受双丝球囊治疗，11例患者单独接受RA治疗或RA联合传统球囊治疗。最后，所有病例均植入药物洗脱支架（DES）。两组之间的基线特征、病变特征和后扩张程序没有差异。在植入DES之前，双丝球囊能够实现充分扩张，产生的裂纹明显多于RA（1.8±0.4条裂纹对1.2±0.6条裂纹，P=0.02）。两组的最小支架横截面积（CSA）和支架扩张率相似。然而，与未使用双丝球囊的患者相比，使用双丝球囊的患者实现了显著的对称扩张（在最小支架CSA部位，通过将最短直径除以最长直径计算的平均比率为0.83±0.05对0.76±0.07，P=0.02）。此外，在随访中，接受双丝球囊治疗的患者未观察到支架内再狭窄。总之，通过在RA后使用双丝球囊，实现了充分的支架扩张和随访结果。这种联合治疗是治疗严重钙化病变的安全可行的方法。
