Schwartz Bryan G, Mayeda Guy S, Economides Christina, Kloner Robert A, Shavelle David M, Burstein Steven
Heart Institute, Good Samaritan Hospital, Los Angeles, California, USA.
Department of Cardiology, Good Samaritan Hospital, Los Angeles, California, USA.
Cardiol Res. 2011 Oct;2(5):208-217. doi: 10.4021/cr78w. Epub 2011 Sep 20.
Left main coronary artery (LMCA) bifurcation and heavily calcified lesions are common and challenging to treat percutaneously. Rotational atherectomy (RA) may be beneficial in this setting to facilitate stent placement though direct supporting evidence is lacking. This study sought to analyze patients who underwent RA of the LMCA.
Consecutive cases involving RA of the LMCA between 1/1/2004 and 12/31/2009 at a private, tertiary referral hospital were reviewed retrospectively. Medical records, angiograms and clinically driven follow-up were reviewed.
Thirty-one cases were identified (20 protected, 11 unprotected), including 23 with stent implantation (21 drug-eluting, 2 bare metal). All 31 lesions had moderate to severe calcification, 84% involved the distal segment. Mean burr-to-vessel ratio was 0.43. Overall angiographic success was 90% (28/31) and was higher with a drug-eluting stent versus no stent (100% vs. 62%; P = 0.0153). In-hospital major adverse cardiovascular events (MACE) occurred in 1 patient (3%). Mid-term MACE occurred in 6 patients (26%) and tended to occur less frequently in patients with protected LMCAs (P = 0.0697). At final follow-up, patients were more likely to be alive and free from angina with a protected LMCA (94% vs. 57% unprotected; P = 0.0564) and with a drug-eluting stent (89% vs. 50% with no stent; P = 0.0281).
RA of the LMCA to facilitate stent implantation appears to be safe and effective with favorable mid-term outcomes. In the setting of severe calcification and distal LMCA involvement RA and drug-eluting stent implantation should be considered.
左冠状动脉主干（LMCA）分叉病变和严重钙化病变较为常见，经皮治疗具有挑战性。旋磨术（RA）在这种情况下可能有助于促进支架置入，尽管缺乏直接的支持证据。本研究旨在分析接受LMCA旋磨术的患者。
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LMCA旋磨术的连续病例。查阅病历、血管造影和临床随访资料。
共纳入31例患者（20例有保护，11例无保护），其中23例植入支架（21例药物洗脱支架，2例裸金属支架）。所有31处病变均有中度至重度钙化，84%累及远端节段。平均磨头与血管直径比为0.43。总体血管造影成功率为90%（28/31），药物洗脱支架组的成功率高于未植入支架组（100%对62%；P = 0.0153）。1例患者（3%）发生院内主要不良心血管事件（MACE）。中期MACE发生在6例患者（26%），有保护的LMCA患者发生频率较低（P = 0.0697）。在末次随访时，有保护的LMCA患者存活且无心绞痛的可能性更高（94%对无保护的57%；P = 0.0564），药物洗脱支架组也更高（89%对未植入支架的50%；P = 0.0281）。
为促进支架置入而进行的LMCA旋磨术似乎安全有效，中期结果良好。在严重钙化和LMCA远端受累的情况下，应考虑旋磨术和药物洗脱支架植入。
