Cardiology Department, Heart Centre Segeberger Kliniken GmbH, Am Kurpark 1, 23795, Bad Segeberg, Germany.
Cardiology Department, Heart Centre Leipzig, University of Leipzig, Leipzig, Germany.
Clin Res Cardiol. 2021 Oct;110(10):1668-1679. doi: 10.1007/s00392-021-01906-y. Epub 2021 Jul 13.
To assess the feasibility and safety of minimal-contrast percutaneous coronary intervention (PCI) using rotational atherectomy (RA) in patients with severe coronary calcification at high-risk of contrast-associated acute kidney injury (AKI).
Twenty-six patients with advanced chronic kidney disease undergoing PCI with RA at three high-volume centres were included. Baseline intravascular ultrasound (IVUS) was performed to assess lesion morphology, and to guide burr-, balloon-, and stent-selection. Final result was assessed by IVUS and angiographically. Feasibility and safety were determined by procedural and in-hospital complications, and efficacy was assessed by freedom from contrast-associated AKI after PCI. Procedural and in-hospital outcome was compared to a propensity-matched population of standard RA PCI.
Mean glomerular filtration rate was 32 ± 17 ml/min/1.73 m. In seven cases PCI was performed in the setting of acute coronary syndrome. The left main coronary artery was treated in 27.8% and a two-stent bifurcation technique in 44.4%. RA was more often performed electively compared to the standard RA cohort (92.3 vs. 50%; p = 0.0016). Angiographic success was achieved in 100% and documented with a median contrast amount of 12.5 ml [Range 4-43]. No in-hospital death or myocardial infarction was reported. Contrast-associated AKI occurred in one patient versus five patients in standard RA group (p = 0.19). Shorter fluoroscopy time and lower radiation dose were achieved as compared to standard RA.
A minimal-contrast RA approach with IVUS-guidance for treatment of complex calcified coronary lesions is feasible and safe with high success rate.
评估在严重冠状动脉钙化且存在对比剂相关急性肾损伤（AKI）高危风险的患者中，采用旋磨术（RA）行最小对比剂经皮冠状动脉介入治疗（PCI）的可行性和安全性。
在三个高容量中心，共纳入 26 名接受 RA 行 PCI 治疗的晚期慢性肾脏病患者。基线血管内超声（IVUS）用于评估病变形态，并指导磨头、球囊和支架的选择。通过 IVUS 和血管造影评估最终结果。通过手术和住院期间的并发症来确定可行性和安全性，并通过 PCI 后对比剂相关 AKI 的无复发率来评估疗效。将手术和住院结果与标准 RA PCI 的倾向评分匹配人群进行比较。
平均肾小球滤过率为 32±17ml/min/1.73m。7 例患者在急性冠状动脉综合征的情况下进行 PCI。左主干冠状动脉病变的处理率为 27.8%，双支架分叉技术的处理率为 44.4%。RA 更多地在择期情况下进行，而不是标准 RA 组（92.3% vs. 50%；p=0.0016）。100%的患者达到了血管造影成功，并记录了中位数为 12.5ml[范围 4-43]的造影剂用量。没有住院期间死亡或心肌梗死发生。与标准 RA 组的 5 例患者相比，仅 1 例患者发生对比剂相关 AKI（p=0.19）。与标准 RA 相比，透视时间更短，辐射剂量更低。
在复杂钙化冠状动脉病变的治疗中，采用 IVUS 指导的最小对比剂 RA 方法是可行和安全的，成功率高。
