Chiou Wei-Ru, Liao Feng-Ching, Su Min-I, Cheng Hsiao-Yang, Chen Yun-Tzy, Lin Wen-Hsiung, Lee Ying-Hsiang, Lin Po-Lin, Wang Kuang-Te
Division of Cardiology, Department of Internal Medicine, Taitung MacKay Memorial Hospital, Taitung.
Department of Medicine, Mackay Medical College, New Taipei.
Acta Cardiol Sin. 2020 May;36(3):233-239. doi: 10.6515/ACS.202005_36(3).20190922A.
Treating heavily calcified lesions is a challenge and is associated with high re-stenosis and target lesion revascularization (TLR). Before stent implantation, lesions must be adequately prepared using rotational atherectomy (RA), which has shown favorable results. The study aims to report our hospital's clinical outcomes when using rotational atherectomy on complex and heavily calcified coronary lesions with a single-burr strategy.
We retrospectively analyzed 58 patients who underwent percutaneous coronary interventions with RA at our center between December 2006 and April 2017. Data on immediate post-procedural events and major adverse cardiovascular events were collected during follow-up, including cardiovascular death, myocardial infarction, TLR, target vessel revascularization (TVR) and stroke.
Of the 58 patients and 90 lesions treated over 10 years, 88 lesions (97.8%) used only one burr. The intervention procedure success rate was 100%. During a mean follow-up of 41.2 months, 6 patients experienced acute coronary syndrome, 12 required TLR, 2 needed TVR, and 6 died due to a cardiovascular event. We divided lesions into 5 categories. The prevalence of lesions and the burr size most commonly used were: category 1 (ostial lesion, 8.9%, 1.75 mm), category 2 (focal lesion, 20%, 1.75 mm), category 3 (intermediate lesion, 13.3%, 1.5 mm), category 4a (long, looser lesion, 26.7%, 1.5 mm), and category 4b (long, rigid lesion, 31.1%, 1.25 mm).
Rather than a routine step-by-step strategy for RA, this study shows convincing evidence supporting the use of this device to treat complex calcified coronary lesions using a single-burr strategy.
治疗严重钙化病变是一项挑战，且与高再狭窄率和靶病变血运重建（TLR）相关。在支架植入前，必须使用旋磨术（RA）对病变进行充分预处理，旋磨术已显示出良好效果。本研究旨在报告我院采用单磨头策略对复杂重度钙化冠状动脉病变进行旋磨术的临床结果。
我们回顾性分析了2006年12月至2017年4月期间在我院中心接受经皮冠状动脉介入治疗并采用旋磨术的58例患者。随访期间收集术后即刻事件和主要不良心血管事件的数据，包括心血管死亡、心肌梗死、TLR、靶血管血运重建（TVR）和中风。
在10年期间治疗的58例患者和90处病变中，88处病变（97.8%）仅使用了一个磨头。介入手术成功率为100%。在平均41.2个月的随访期间，6例患者发生急性冠状动脉综合征，12例需要进行TLR，2例需要TVR，6例因心血管事件死亡。我们将病变分为5类。病变的发生率和最常用的磨头尺寸分别为：1类（开口病变，8.9%，1.75mm），2类（局灶性病变，20%，1.75mm），3类（中间病变，13.3%，1.5mm），4a类（长、较疏松病变，26.7%，1.5mm），4b类（长、僵硬病变，31.1%，1.25mm）。
本研究并非采用RA的常规逐步策略，而是显示出令人信服的证据支持使用该设备采用单磨头策略治疗复杂钙化冠状动脉病变。
