McCluskey E R, Cowley M, Whitlow P L
Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195.
Am J Cardiol. 1993 Oct 18;72(13):42E-46E. doi: 10.1016/0002-9149(93)91037-i.
Directional coronary atherectomy (DCA) has been proposed as a "rescue" technique for failed or suboptimal percutaneous transluminal coronary angioplasty (PTCA) in an attempt to avoid myocardial infarction or emergency coronary artery bypass grafting. In this report we review the utilization and outcome of rescue atherectomy from the clinical experience of The Cleveland Clinic Foundation and Medical College of Virginia from November 1988 through January 1993, and from the Coronary Angioplasty Versus Excisional Atherectomy Trial (CAVEAT) database. This analysis includes 100 patients with 103 treated lesions from 44 patients at the Cleveland Clinic, 36 patients from the Medical College of Virginia, and 20 patients from the CAVEAT database. The etiology of failed PTCA was primarily from dissection in 52 lesions (50.5%), "recoil" in 43 lesions (41.8%), and recurrent thrombosis in 8 lesions (7.8%). Complete vessel closure was present in 23 lesions (22.3%). The vessels treated included 51.5% left anterior descending, 24.3% right coronary, and 16.5% circumflex coronary arteries. The average reference vessel diameter in the group was 3.10 +/- 0.06 mm (SEM), with an average stenosis of 78.9 +/- 1.2% before PTCA, 55.8 +/- 2.4% after PTCA, and 24.1 +/- 2.2% after rescue DCA. DCA was successful (Thrombosis in Myocardial Infarction [TIMI] grade 3 flow with > 20% stenosis reduction without death, Q-wave myocardial infarction, or coronary artery bypass grafting) in 94 of 103 lesions (91.3%). Complications included 1 patient with perforation (1%), 2 deaths within 24 hours (2.0%), and 6 patients requiring coronary artery bypass grafting (6%).(ABSTRACT TRUNCATED AT 250 WORDS)
定向冠状动脉斑块旋切术（DCA）已被提议作为一种针对失败或效果欠佳的经皮腔内冠状动脉成形术（PTCA）的“补救”技术，旨在避免心肌梗死或急诊冠状动脉搭桥术。在本报告中，我们根据克利夫兰诊所基金会和弗吉尼亚医学院1988年11月至1993年1月的临床经验以及冠状动脉成形术与斑块切除旋切术试验（CAVEAT）数据库，回顾了补救性斑块旋切术的应用情况及结果。该分析包括来自克利夫兰诊所的44例患者的103处治疗病变、弗吉尼亚医学院的36例患者以及CAVEAT数据库的20例患者。PTCA失败的病因主要为52处病变（50.5%）出现夹层、43处病变（41.8%）出现“回缩”以及8处病变（7.8%）出现复发性血栓形成。23处病变（22.3%）存在完全血管闭塞。所治疗的血管包括51.5%的左前降支、24.3%的右冠状动脉以及16.5%的左旋支冠状动脉。该组患者的平均参考血管直径为3.10±0.06毫米（标准误），PTCA前平均狭窄率为78.9±1.2%，PTCA后为55.8±2.4%，补救性DCA后为24.1±2.2%。103处病变中有94处（91.3%）DCA成功（心肌梗死溶栓[TIMI]3级血流，狭窄率降低>20%，无死亡、Q波心肌梗死或冠状动脉搭桥术）。并发症包括1例穿孔患者（1%）、24小时内2例死亡（2.0%）以及6例需要冠状动脉搭桥术的患者（6%）。（摘要截于250字）
