Allan Matthew, Vickers Dominic, Pitney Mark, Jepson Nigel
Prince of Wales Hospital, Sydney, Australia; The Sutherland Hospital, Sydney, Australia; The University of New South Wales, Sydney, Australia.
The University of New South Wales, Sydney, Australia.
Cardiovasc Revasc Med. 2019 Jul;20(7):559-562. doi: 10.1016/j.carrev.2018.08.019. Epub 2018 Aug 25.
Refractory coronary in-stent restenosis remains a clinically relevant problem in interventional cardiology despite the use of drug coated balloon angioplasty and further drug eluting stent deployment. In this study, we investigated whether the novel approach of lesion debulking with rotational atherectomy prior to drug coated balloon angioplasty for challenging coronary in-stent restenosis is safe and effective.
Procedural and registry data was retrospectively analysed for 26 patients who underwent rotational atherectomy immediately followed by drug coated balloon angioplasty to 43 coronary in-stent restenosis lesions with mean follow up of 19 months.
Lesion success was achieved in all cases with no major procedural complications. There were no instances of death or myocardial infarction in the follow up period. Target lesion revascularisation occurred in six patients and target vessel revascularisation occurred in eight patients. All target lesion revascularisation occurred in lesions that had already failed drug coated balloon angioplasty without debulking previously while four such lesions were free of lesion failure in the follow up period.
Lesion debulking with rotational atherectomy followed by drug coated balloon angioplasty is a feasible treatment option for selected cases of in-stent restenosis. Further study is needed to fully assess its efficacy in comparison to conventional treatment.
尽管使用了药物涂层球囊血管成形术及进一步的药物洗脱支架植入术，但难治性冠状动脉支架内再狭窄仍是介入心脏病学中一个具有临床相关性的问题。在本研究中，我们调查了对于具有挑战性的冠状动脉支架内再狭窄，在药物涂层球囊血管成形术前采用旋磨术进行病变减容的新方法是否安全有效。
对26例接受旋磨术随后立即进行药物涂层球囊血管成形术治疗43处冠状动脉支架内再狭窄病变的患者的手术及登记数据进行回顾性分析，平均随访19个月。
所有病例均实现病变成功，无重大手术并发症。随访期间无死亡或心肌梗死病例。6例患者发生靶病变血运重建，8例患者发生靶血管血运重建。所有靶病变血运重建均发生在先前未进行减容的药物涂层球囊血管成形术失败的病变中，而4处此类病变在随访期间无病变失败情况。
旋磨术进行病变减容后再行药物涂层球囊血管成形术是部分支架内再狭窄病例的可行治疗选择。与传统治疗相比，需要进一步研究以充分评估其疗效。
