Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA.
Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, NY, New York, USA.
Cardiovasc Revasc Med. 2022 Jan;34:32-37. doi: 10.1016/j.carrev.2021.01.011. Epub 2021 Jan 14.
There is no consensus on the best treatment of undilatable coronary in-stent restenosis (ISR) regardless of the number of stent layers. We aimed to evaluate the procedural and clinical outcomes of rotational atherectomy (RA) to treat undilatable coronary ISR with single or multiple stent layers.
We retrospectively evaluated consecutive patients treated with RA for undilatable ISR with single or multiple stent layers in the Mount Sinai catheterization laboratory between January 2016 and September 2018. Procedural success was defined as angiographic success without in-hospital major adverse cardiac events (MACE): a composite of death, myocardial infarction (MI), and target lesion revascularization (TLR). Clinical outcomes were assessed at one-year post-procedure.
A total of 26 patients were included in the study, in which 18 (69.2%) patients were with multiple stent layers. After RA, 9 (34.6%) were received a new drug-eluting stent, and 6 (23.1%) were treated with intravascular brachytherapy. Angiographic success was achieved in 24 (92.3%) patients, and procedural success was achieved in 22 (84.6%) patients. In-hospital MACE occurred in 4 (15.4%) patients, all due to periprocedural non-Q wave MI. Within one year, MACE occurred in 9 (34.6%) patients with 5 (19.2%) TLR.
RA for undilatable ISR with single or multiple stent layers was performed with favorable procedural outcomes and a relatively high MACE rate driven by TLR within one year.
对于数量不一的支架内再狭窄（ISR），无论支架层数多少，目前仍未达成关于最佳治疗方法的共识。我们旨在评估旋磨术（RA）治疗单支架或多支架内再狭窄的有效性和安全性。
我们回顾性分析了 2016 年 1 月至 2018 年 9 月在西奈山导管室接受 RA 治疗的单支架或多支架内再狭窄患者。手术成功定义为无院内主要不良心脏事件（MACE）的血管造影成功：死亡、心肌梗死（MI）和靶病变血运重建（TLR）的复合终点。术后 1 年评估临床结果。
共纳入 26 例患者，其中 18 例（69.2%）患者为多支架层。RA 后，9 例（34.6%）患者接受了新的药物洗脱支架，6 例（23.1%）患者接受了血管内放射治疗。24 例（92.3%）患者达到了血管造影成功，22 例（84.6%）患者达到了手术成功。住院期间发生 4 例（15.4%）MACE，均为围手术期非 Q 波 MI。在 1 年内，9 例（34.6%）患者发生 MACE，其中 5 例（19.2%）患者发生 TLR。
对于单支架或多支架内再狭窄，旋磨术治疗效果良好，但 1 年内 TLR 导致的 MACE 发生率较高。
