Naganuma Toru, Kawamoto Hiroyoshi, Takagi Kensuke, Yabushita Hiroto, Mitomo Satoru, Watanabe Yusuke, Shirai Shinichi, Araki Motoharu, Tada Norio, Yamanaka Futoshi, Yamamoto Masanori, Onishi Hirokazu, Nakamura Sunao, Higashimori Akihiro, Tabata Minoru, Mizutani Kazuki, Ueno Hiroshi, Hayashida Kentaro
New Tokyo Hospital, Matsudo, Japan.
New Tokyo Hospital, Matsudo, Japan.
Cardiovasc Revasc Med. 2017 Jul-Aug;18(5):356-360. doi: 10.1016/j.carrev.2017.02.018. Epub 2017 Feb 28.
The aim of this study was to report the safety of coronary rotational atherectomy (RA) in patients with severe aortic stenosis (AS). RA in the clinical setting seems challenging because coronary slow flow leads to hemodynamic instability.
Between October 2013 and May 2016, 1401 patients in the Optimized transCathEter vAlvular iNtervention (OCEAN) registry in Japan underwent transcatheter aortic valve implantation (TAVI). The primary study endpoint was procedural success, defined as residual stenosis <20% with final Thrombolysis in Myocardial Infarction flow 3.
Twenty-five patients who underwent RA for heavily calcified lesions were included in the study. Low left ventricular ejection fraction (<35%) was present in 3 (12%) patients. The left main stem was involved in 7 (28%) patients. All patients were treated under intravascular image guidance. Intra-aortic balloon pumping was used in 4 (16%) patients. Planned balloon aortic valvuloplasty (BAV) was performed during the same session in 4 (16%) patients. Transvenous catecholamine was used in 10 (40%) patients. The majority of patients underwent drug-eluting stent implantation following RA (n=23, 92%). Procedural success was achieved in all patients. Subsequent device success was achieved in 24 (96%) patients, with no 30-day mortality following TAVI.
RA in patients with severe AS seems extremely challenging; however, this procedure appears to be safe if mechanical and drug supports are appropriately utilized and the procedure is performed under intravascular image guidance.
本研究旨在报告严重主动脉瓣狭窄（AS）患者行冠状动脉旋磨术（RA）的安全性。在临床环境中，RA似乎具有挑战性，因为冠状动脉血流缓慢会导致血流动力学不稳定。
2013年10月至2016年5月期间，日本优化经导管瓣膜介入治疗（OCEAN）注册研究中的1401例患者接受了经导管主动脉瓣植入术（TAVI）。主要研究终点为手术成功，定义为残余狭窄<20%且最终心肌梗死溶栓血流为3级。
25例行RA治疗严重钙化病变的患者纳入本研究。3例（12%）患者左心室射血分数低（<35%）。7例（28%）患者累及左主干。所有患者均在血管内影像引导下接受治疗。4例（16%）患者使用了主动脉内球囊泵。4例（16%）患者在同一手术过程中计划行球囊主动脉瓣成形术（BAV）。10例（40%）患者使用了经静脉儿茶酚胺。大多数患者在RA后接受了药物洗脱支架植入（n = 23，92%）。所有患者均实现了手术成功。随后24例（96%）患者实现了器械成功，TAVI后无30天死亡率。
严重AS患者行RA似乎极具挑战性；然而，如果适当利用机械和药物支持并在血管内影像引导下进行该手术，该手术似乎是安全的。
