Dietz U, Erbel R, Rupprecht H J, Weidmann S, Meyer J
Second Medical Clinic, Johannes Gutenberg University, Mainz, Germany.
Cathet Cardiovasc Diagn. 1994 Mar;31(3):179-86. doi: 10.1002/ccd.1810310304.
Percutaneous transluminal coronary angioplasty (PTCA) failed in 29 of 1,150 patients (2.5%) after successful passage of the guide wire. The reasons for failure were inability to pass the lesion with a balloon in 28 patients and inability to dilate the lesion in 1 patient. In these patients (15 stenoses and 14 chronic occlusions) rotational ablation was performed. We were able to pass the burr through the lesion in all of them, resulting in a reduction of diameter stenosis from 87 +/- 15 to 51 +/- 18%. Rotational ablation alone was initially successful (stenoses reduction > 20% and residual stenoses < 50%) in 15 of 29 (52%) patients. Additional PTCA was performed in 21 of 29 (72%) patients, in 8 to optimize the initially successful result and in 13 because the outcome was unsatisfactory. After dilatation the diameter stenosis was reduced to 41 +/- 14% immediately after the procedure and to 36 +/- 13% at 24 hr control. Overall success was achieved in 21 of 29 (72%) patients immediately after the procedure and in 26 of 29 (90%) patients at 24 hr control. No acute major complications occurred. We conclude that rotational ablation can be used as a safe and effective alternative when PTCA is not successful.
在1150例患者中，29例（2.5%）在导丝成功通过后经皮腔内冠状动脉成形术（PTCA）失败。失败原因包括28例患者球囊无法通过病变部位，1例患者病变无法扩张。对这些患者（15处狭窄和14处慢性闭塞）进行了旋磨术。我们能够使磨头通过所有病变部位，直径狭窄率从87±15%降至51±18%。仅旋磨术最初成功（狭窄率降低>20%且残余狭窄<50%）的患者有29例中的15例（52%）。29例患者中有21例（72%）进行了额外的PTCA，其中8例是为了优化最初的成功结果，13例是因为结果不理想。扩张后，术后即刻直径狭窄率降至41±14%，24小时复查时降至36±13%。术后即刻29例患者中有21例（72%）总体成功，24小时复查时29例患者中有26例（90%）成功。未发生急性严重并发症。我们得出结论，当PTCA不成功时，旋磨术可作为一种安全有效的替代方法。
