Hong M K, Wong S C, Mintz G S, Farb A, Kent K M, Pichard A D, Satler L F, Popma J J, Sidawy A, Virmani R
Department of Internal Medicine, Washington Hospital Center, Washington, DC, USA.
Coron Artery Dis. 1995 Apr;6(4):335-9. doi: 10.1097/00019501-199504000-00011.
The purpose of this study was to determine the feasibility of resecting calcified atherosclerotic plaques in human cadaveric vessels by using a modified directional coronary atherectomy catheter and to correlate these results with bench tests using an in-vitro sea coral model.
The conventional directional coronary atherectomy catheter was modified by changing the cutter blade to a tungsten carbide material and by increasing the torsional strength of the drive cable. The performance of the modified directional coronary atherectomy (DCA) catheter was compared with the conventional catheter using a sea coral model to simulate calcified material. Then, 10 human ex-vivo arteries (eight with calcification) were treated with both conventional and modified catheters, and the results studied with intravascular ultrasound and confirmed by histologic examination.
Using the modified directional coronary atherectomy catheter it was possible to perform effective and consistent longitudinal cutting, and to resect a significantly larger amount of coral (1.0 +/- 0.1 mm2 versus 0.2 +/- 0.1 mm2 with conventional cutter, P < 0.0001). In heavily calcified ex-vivo arteries, the modified catheter was more effective in removing calcified plaques (13 +/- 11 mg versus 3.7 +/- 1.4 mg with conventional cutter, P = 0.07). Intravascular ultrasound confirmed the effective atherectomy (residual area stenosis 28 +/- 16% versus 47 +/- 10% with the conventional device, P < 0.05), and histologic examination showed calcified nodules in the atherectomy samples obtained with the modified cutter (area of calcium 1.43 +/- 0.89 mm2 versus 0.93 +/- 0.83 mm2 with the conventional cutter).
The modified directional coronary atherectomy catheter effectively removed both non-calcified and calcified plaques in the ex-vivo human cadaveric arteries, thus demonstrating the feasibility of directional coronary atherectomy of calcified plaques. This modified device shows promise for treating calcified coronary lesions, especially in larger vessels.
本研究的目的是确定使用改良的定向冠状动脉斑块旋切导管切除人体尸体血管中钙化动脉粥样硬化斑块的可行性，并将这些结果与使用体外海珊瑚模型的台架试验结果相关联。
通过将切割刀片更换为碳化钨材料并增加驱动电缆的抗扭强度，对传统的定向冠状动脉斑块旋切导管进行改良。使用海珊瑚模型模拟钙化物质，将改良后的定向冠状动脉斑块旋切（DCA）导管的性能与传统导管进行比较。然后，使用传统导管和改良导管对10条人体离体动脉（8条有钙化）进行处理，并通过血管内超声研究结果，并用组织学检查进行确认。
使用改良的定向冠状动脉斑块旋切导管能够进行有效且一致的纵向切割，并切除显著更多的珊瑚（1.0±0.1平方毫米，而传统切割器为0.2±0.1平方毫米，P<0.0001）。在严重钙化的离体动脉中，改良导管在去除钙化斑块方面更有效（13±11毫克，而传统切割器为3.7±1.4毫克，P = 0.07）。血管内超声证实斑块旋切有效（残余面积狭窄为28±16%，而传统器械为47±10%，P<0.05），组织学检查显示使用改良切割器获得的斑块旋切样本中有钙化结节（钙面积为1.43±0.89平方毫米，而传统切割器为0.93±0.83平方毫米）。
改良的定向冠状动脉斑块旋切导管有效地去除了人体尸体离体动脉中的非钙化和钙化斑块，从而证明了钙化斑块定向冠状动脉斑块旋切术的可行性。这种改良装置在治疗钙化冠状动脉病变方面显示出前景，尤其是在较大血管中。
