Whiteside Hoyle L, Nagabandi Arun, Kapoor Deepak
Division of Internal Medicine, Medical College of Georgia at Augusta University, Augusta, GA, USA.
Columbia University Division of Cardiology, Mount Sinai Medical Center, Miami Beach, FL, USA.
Cardiovasc Revasc Med. 2019 Nov;20(11):985-989. doi: 10.1016/j.carrev.2019.01.013. Epub 2019 Jan 15.
Coronary stent underexpansion is associated with in-stent restenosis and few interventions are available for the management of undilatable underexpanded stents. Stentablation (SA) with rotational atherectomy (RA) is a unique application and has previously been described with encouraging results. Data regarding SA is limited to case reports and small case series; therefore, reasonable concern persists regarding procedural safety and long-term outcomes.
This is a single-center retrospective study analyzing twenty consecutive patients who underwent SA with RA. The primary endpoint was procedural success and secondary endpoints included procedural safety outcomes and major adverse cardiac events (MACE) over a 12-month follow-up period.
Stentablation and secondary stenting were guided by intravascular ultrasound and procedural success was achieved in all cases. No in-hospital death or MACE was observed. The prevalence of MACE was 5% at 30 days as one patient developed recurrent MI without target lesion revascularization (TLR). At 12 months, MACE had occurred in 40% of patients, however this was strongly driven by a high prevalence of TLR (30%). Only one cardiac death (5%) and one additional NSTEMI were observed during the 11 additional months of follow up.
Stentablation with RA is a feasible and effective option for the acute management of symptomatic, underexpanded, and undilatable coronary stents. SA is associated with a high rate of procedural success as well as excellent in-hospital and short-term outcomes. However, our study population demonstrated substantial MACE at 12 months which was strongly driven by TLR and associated with minimal mortality.
冠状动脉支架扩张不足与支架内再狭窄相关，对于不可扩张的扩张不足支架，可用的干预措施很少。采用旋磨术（RA）进行支架消融（SA）是一种独特的应用，此前已有报道取得了令人鼓舞的结果。关于SA的数据仅限于病例报告和小病例系列；因此，对于手术安全性和长期结果仍存在合理担忧。
这是一项单中心回顾性研究，分析了连续20例接受SA联合RA治疗的患者。主要终点是手术成功，次要终点包括手术安全结果和12个月随访期内的主要不良心脏事件（MACE）。
血管内超声引导下进行支架消融和二次支架置入，所有病例均取得手术成功。未观察到院内死亡或MACE。30天时MACE发生率为5%，因为有1例患者发生复发性心肌梗死且未进行靶病变血管重建（TLR）。12个月时，40%的患者发生了MACE，然而这主要是由高发生率的TLR（30%）驱动的。在额外的11个月随访期间，仅观察到1例心源性死亡（5%）和1例额外的非ST段抬高型心肌梗死。
采用RA进行支架消融是有症状、扩张不足且不可扩张的冠状动脉支架急性处理的一种可行且有效的选择。SA与高手术成功率以及良好的院内和短期结果相关。然而，我们的研究人群在12个月时显示出大量MACE，这主要由TLR驱动，且死亡率极低。
