Lee Michael S, Shlofmitz Evan, Shlofmitz Richard
UCLA Medical Center, 100 Medical Plaza, Suite 630, Los Angeles, CA 90095 USA.
J Invasive Cardiol. 2018 Aug;30(8):310-314.
We evaluated the outcomes of plaque modification with orbital atherectomy followed by percutaneous coronary intervention (PCI) with small-diameter stents for severely calcified coronary arteries.
PCI of severely calcified lesions is technically complex due to difficulties in predilating the lesion, delivering the stent, and achieving optimal stent expansion. PCI of small-diameter vessels is associated with an increased risk of adverse clinical events.
In our retrospective multicenter registry of 458 "all comers" with severe coronary artery calcification treated with orbital atherectomy, a total of 38 patients (8.3%) underwent stenting with a 2.5 mm diameter stent (small-vessel group) and 420 patients (91.7%) had a reference vessel diameter >2.5 mm (large-vessel group). The primary endpoint was the 30-day rate of major adverse cardiac and cerebrovascular events, which was the composite of death, myocardial infarction (MI), target-vessel revascularization (TVR), and stroke.
The small-vessel and large-vessel groups had similar rates of perforation (0.0% vs 0.7%; P=.80), dissection (2.6% vs 0.7%; P=.20), and no-reflow (0.0% vs 0.7%; P=.80). The primary endpoint was similar in both groups (0.0% vs 1.9%; P=.40), as were the rates of death (0.0% vs 1.4%; P=.40), MI (0.0% vs 1.2%; P=.50), TVR (0.0% vs 0.0%; P>.99), and stroke (0.0% vs 0.2%; P=.90). The small-vessel and large-vessel groups had similar rates of stent thrombosis (0.0% vs 1.0%; P=.70).
Orbital atherectomy followed by stenting of small-diameter vessels appears to be feasible and safe. Further studies are needed to determine the ideal revascularization strategy for these patients.
我们评估了采用轨道旋磨术进行斑块修饰，随后使用小直径支架行经皮冠状动脉介入治疗（PCI）严重钙化冠状动脉的效果。
严重钙化病变的PCI在技术上较为复杂，因为病变预扩张、输送支架以及实现最佳支架扩张存在困难。小直径血管的PCI与不良临床事件风险增加相关。
在我们对458例接受轨道旋磨术治疗的严重冠状动脉钙化“所有患者”的回顾性多中心注册研究中，共有38例患者（8.3%）接受了直径2.5毫米支架的置入（小血管组），420例患者（91.7%）的参考血管直径>2.5毫米（大血管组）。主要终点是30天主要不良心脑血管事件发生率，其为死亡、心肌梗死（MI）、靶血管血运重建（TVR）和中风的复合事件。
小血管组和大血管组的穿孔率（0.0%对0.7%；P = 0.80）、夹层形成率（2.6%对0.7%；P = 0.20）和无复流率（0.0%对0.7%；P = 0.80）相似。两组的主要终点相似（0.0%对1.9%；P = 0.40），死亡发生率（0.0%对1.4%；P = 0.40）、MI发生率（0.0%对1.2%；P = 0.50）、TVR发生率（0.0%对0.0%；P>0.99）和中风发生率（0.0%对0.2%；P = 0.90）也相似。小血管组和大血管组的支架血栓形成率相似（0.0%对1.0%；P = 0.70）。
轨道旋磨术随后进行小直径血管支架置入似乎是可行且安全的。需要进一步研究以确定这些患者理想的血运重建策略。
