Farb A, Roberts D K, Pichard A D, Kent K M, Virmani R
Department of Cardiovascular Pathology, Armed Forces Institute of Pathology, Washington, D.C. 20306-6000, USA.
Am Heart J. 1995 Jun;129(6):1058-67. doi: 10.1016/0002-8703(95)90384-4.
The coronary arteries and myocardium from two patients who died after coronary rotational atherectomy were analyzed to gain insights into the mechanisms of lumen enlargement and to document embolization of calcified plaque. Rotational atherectomy resulted in sharp cuts in plaque, producing a relatively smooth luminal surface. When extensive nodular calcific atherosclerosis was present, the luminal surface was focally uneven with exposure of jagged calcified plaque to blood flow. Deep plaque fissures and medial dissections were also seen. These fissures may have been created by the rotoblator or by adjunctive balloon angioplasty. Multiple calcific atheroemboli were present after rotoblator use in plaques containing extensive nodular calcification; in moderately calcified plaque only one small atheroembolus was found. Thus embolization of calcified plaque can occur after rotational atherectomy and may correlate with the severity of plaque calcification. Rotational atherectomy produces a focally smooth, sharp-edged, luminal surface, a lumen enlargement mechanism different from balloon angioplasty.
对两名在冠状动脉旋切术后死亡患者的冠状动脉和心肌进行分析，以深入了解管腔扩大机制并记录钙化斑块的栓塞情况。旋切术导致斑块出现锐利切口，形成相对光滑的管腔表面。当存在广泛的结节状钙化动脉粥样硬化时，管腔表面局部不平整，锯齿状钙化斑块暴露于血流中。还可见到深层斑块裂隙和中膜剥离。这些裂隙可能是由旋切刀或辅助球囊血管成形术造成的。在使用旋切刀处理含有广泛结节状钙化斑块后出现多个钙化动脉粥样硬化栓子；在中度钙化斑块中仅发现一个小的动脉粥样硬化栓子。因此，钙化斑块栓塞可在旋切术后发生，且可能与斑块钙化的严重程度相关。旋切术产生局部光滑、边缘锐利的管腔表面，这是一种与球囊血管成形术不同的管腔扩大机制。
