Cao Cheng-Fu, Ma Yu-Liang, Li Qi, Liu Jian, Zhao Hong, Lu Ming-Yu, Wang Wei-Min
Department of Cardiology, Peking University People's Hospital, No.11 Xizhimen South Street, Beijing, China.
Herz. 2022 Dec;47(6):536-542. doi: 10.1007/s00059-021-05073-8. Epub 2022 Feb 11.
Rotational atherectomy (RA) has improved percutaneous treatment of severely calcified coronary lesions, but the "no-reflow" phenomenon remains a serious complication. Platelet activation by RA may contribute to no-reflow, and the use of optical coherence tomography (OCT) to test the effect of RA on white thrombus could confirm platelet activation indirectly.
We analyzed 53 consecutive patients with severely calcified lesions on coronary angiography. All patients were examined with OCT. In total, 20 patients who received RA and for whom OCT imaging was performed before and after RA and stent implantation comprised the RA group. The remaining 33 patients formed the control group, for whom OCT imaging was performed before balloon dilatation and after stent implantation.
The patients in the RA group were older and had a higher incidence of diabetes mellitus. In the control group, there was no thrombogenesis during the procedure, whereas in the RA group, all the target vessels had white thrombi on OCT after RA. The average number of white thrombi per lesion after RA was 7.23 ± 4.4, and the average length of white thrombus was 0.51 ± 0.33 mm. Statistical analysis with Pearson's correlation coefficient showed that thrombus load was related to burr size (r = 0.575, p = 0.040) and number of rotations (r = 0.599, p = 0.031).
White thrombi during RA can be verified by performing OCT. Treating calcified lesions with RA may enhance thrombogenesis. These data suggest using appropriate therapy to avoid no-reflow during RA.
旋磨术（RA）改善了严重钙化冠状动脉病变的经皮治疗，但“无复流”现象仍然是一个严重的并发症。RA引起的血小板激活可能导致无复流，而使用光学相干断层扫描（OCT）检测RA对白色血栓的影响可间接证实血小板激活。
我们分析了53例冠状动脉造影显示严重钙化病变的连续患者。所有患者均接受OCT检查。共有20例接受RA且在RA和支架植入前后进行了OCT成像的患者组成RA组。其余33例患者组成对照组，在球囊扩张前和支架植入后进行OCT成像。
RA组患者年龄较大，糖尿病发病率较高。对照组在手术过程中未发生血栓形成，而RA组在RA后OCT显示所有靶血管均有白色血栓。RA后每个病变白色血栓的平均数量为7.23±4.4，白色血栓的平均长度为0.51±0.33mm。Pearson相关系数统计分析显示，血栓负荷与磨头尺寸（r = 0.575，p = 0.040）和旋磨次数（r = 0.599，p = 0.031）相关。
通过OCT可证实RA过程中存在白色血栓。用RA治疗钙化病变可能会增强血栓形成。这些数据提示在RA期间应采用适当的治疗方法以避免无复流。
