Lee Michael S, Shlofmitz Evan, Kong Jeremy, Srivastava Pratyaksh K, Al Yaseen Saif, Sosa Fernando A, Gallant Melissa, Shlofmitz Richard
Division of Cardiology, UCLA Medical Center, Los Angeles, California.
Cardiovascular Research Foundation, New York, New York.
J Interv Cardiol. 2018 Feb;31(1):15-20. doi: 10.1111/joic.12432. Epub 2017 Sep 4.
We assessed the feasibility and safety of orbital atherectomy in patients with severely calcified aorto-ostial coronary artery lesions.
The treatment of calcified aorta-ostial coronary artery lesions is technically challenging. Orbital atherectomy can potentially damage the guiding catheter if it is not retracted sufficiently during treatment of ostial lesions. Orbital atherectomy can also excessively whip if the guiding catheter is not close enough to the ostium to provide sufficient support. Several techniques can be performed to successfully treat ostial lesions with orbital atherectomy.
Our retrospective multicenter registry included 548 real-world patients who underwent orbital atherectomy, 59 (10.8%) of whom underwent treatment for aorto-ostial coronary artery lesions (left main artery [n = 35] and right coronary artery [n = 24]). The primary endpoint was the rate of 30-day major adverse cardiac and cerebrovascular events (MACCE), defined as the occurrence of death, myocardial infarction, target vessel revascularization, and stroke.
The primary endpoint was similar in patients with and without ostial lesions (3.4% vs 2.2%, P = 0.2), as were the 30-day rates of death (1.7% vs 1.4%, P = 0.7), myocardial infarction (1.7% vs 1.0%, P = 0.3), target vessel revascularization (0% vs 0%, P > 0.91), and stroke (0% vs 0.2%, P > 0.9). Angiographic complications and stent thrombosis did not occur in patients with ostial lesions.
Despite its technical challenges, orbital atherectomy appears to be a feasible and safe treatment option for calcified aorto-ostial coronary lesions.
我们评估了在严重钙化的主动脉开口处冠状动脉病变患者中进行轨道旋磨术的可行性和安全性。
钙化的主动脉开口处冠状动脉病变的治疗在技术上具有挑战性。在开口处病变治疗期间，如果引导导管没有充分回撤，轨道旋磨术可能会损坏引导导管。如果引导导管距离开口不够近以提供足够支撑，轨道旋磨术也可能过度摆动。可以采用几种技术来成功地用轨道旋磨术治疗开口处病变。
我们的回顾性多中心注册研究纳入了548例接受轨道旋磨术的真实世界患者，其中59例（10.8%）接受了主动脉开口处冠状动脉病变的治疗（左主干[n = 35]和右冠状动脉[n = 24]）。主要终点是30天主要不良心脑血管事件（MACCE）发生率，定义为死亡、心肌梗死、靶血管血运重建和中风的发生。
有开口处病变和无开口处病变的患者的主要终点相似（3.4%对2.2%，P = 0.2），30天死亡率（1.7%对1.4%，P = 0.7）、心肌梗死发生率（1.7%对1.0%，P = 0.3）、靶血管血运重建率（0%对0%，P>0.91）和中风发生率（0%对0.2%，P>0.9）也相似。开口处病变患者未发生血管造影并发症和支架血栓形成。
尽管存在技术挑战，但轨道旋磨术似乎是治疗钙化的主动脉开口处冠状动脉病变的一种可行且安全的选择。
