Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan.
Am J Cardiol. 2012 Aug 15;110(4):498-501. doi: 10.1016/j.amjcard.2012.04.021. Epub 2012 May 12.
Although rotational atherectomy (RA) is used for complex lesions in percutaneous coronary intervention, there are several contraindications and precautions. The purpose of our study was to compare complications between off-label and on-label use of RA. We identified 250 consecutive patients who underwent RA. Off-label characteristics included saphenous vein graft lesions, presence of thrombus, unprotected left main stenosis, coronary artery dissection, acute myocardial infarction (MI), left ventricular dysfunction, 3-vessel disease, long lesion (≥ 25 mm), or angulated lesion (≥ 45°). Patients who had ≥ 1 off-label characteristic were assigned to the off-label group (156 patients), and patients who had no off-label characteristics were assigned to the on-label group (94 patients). Occurrence of slow flow or periprocedural MI in the off-label group was higher than that in the on-label group (slow flow 30% vs 18%, p = 0.06; MI 8.8% vs 2.1%, p = 0.04), whereas severe complications such as burr entrapment, transection of the guidewire, or perforation were rare in the 2 groups. In conclusion, compared to the on-label group, the off-label group had a higher incidence of slow flow and periprocedural MI. Severe complications such as burr entrapment, transection of the guidewire, or perforation were rare in the 2 groups.
虽然旋转血管成形术（RA）用于经皮冠状动脉介入治疗中的复杂病变，但存在一些禁忌症和注意事项。我们的研究目的是比较 RA 的标签外和标签内使用的并发症。我们确定了 250 例连续接受 RA 治疗的患者。标签外特征包括隐静脉移植物病变、血栓形成、无保护的左主干狭窄、冠状动脉夹层、急性心肌梗死（MI）、左心室功能障碍、3 支血管病变、长病变（≥25mm）或成角病变（≥45°）。具有≥1个标签外特征的患者被分配到标签外组（156 例），没有标签外特征的患者被分配到标签内组（94 例）。标签外组的慢血流或围手术期 MI 的发生率高于标签内组（慢血流 30% vs 18%，p=0.06；MI 8.8% vs 2.1%，p=0.04），而两组均罕见严重并发症，如磨头嵌顿、导丝断裂或穿孔。总之，与标签内组相比，标签外组的慢血流和围手术期 MI 发生率较高。两组均罕见严重并发症，如磨头嵌顿、导丝断裂或穿孔。
