Dietz U, Erbel R, Rupprecht H J, Weidmann S, Meyer J
Second Medical Clinic, Johannes Gutenberg University, Mainz, Germany.
Br Heart J. 1993 Oct;70(4):327-36. doi: 10.1136/hrt.70.4.327.
To prove the safety and effectiveness of high frequency rotational ablation of coronary artery stenoses and occlusion in humans.
106 patients with symptoms (91 men, 15 women) who had 67 significant stenoses, mainly types B and C, and 46-chronic occlusions.
Mean change in diameter stenosis after rotational angioplasty alone and in combination with percutaneous transluminal coronary angioplasty immediately after treatment and 24 hours and six months later; restenosis rates at six months; complication of treatment.
Rotational ablation could not be used in five stenoses and 16 chronic occlusions because of inability to reach or cross the lesion with the Rotablator guide wire. In four cases rotational ablation failed. Initial angiographic and clinical success by rotational ablation was achieved in 40 of the 67 stenoses (60%) and in 18 of the 46 chronic occlusions (39%). Additional balloon angioplasty was performed in 45 patients, increasing the success rates to 79% and 54%, respectively. In the 62 stenoses treated by rotational ablation the angiographic diameter stenoses were reduced from 76% (SD 14%) to 32% (14%) after Rotablator treatment alone and from 75% (11%) to 33% (17%) with additional balloon angioplasty. In the 30 chronic occlusions treated by rotational ablation the angiographic diameter stenoses were reduced to 38% (18%). At six months angiographic restenosis was evident in nine of the 25 (36%) stenoses treated with rotational ablation alone, in seven of the 22 (32%) stenoses treated with rotational and balloon angioplasty, and in 14 of the 24 (58%) chronic occlusions. There were no procedural deaths and two patients (2%) underwent emergency coronary artery bypass grafting. Although no transmural infarction occurred, there were five (6%) non-Q wave infarctions (two embolic side branch occlusions, two subacute occlusions, and one acute occlusion). Clinically insignificant slight increases in creatine kinase activity were seen in five patients (6%). Severe coronary artery spasm unresponsive to medical treatment was provoked in seven cases (8%).
High frequency rotational ablation is a safe and effective method for treating type B and C coronary artery lesions with results comparable to percutaneous transluminal coronary balloon angioplasty. The combined use of rotational ablation and balloon angioplasty is feasible and is necessary in about half of all procedures, in most cases because the lumen created by the biggest burr is too small.
证实高频旋转消融术治疗人类冠状动脉狭窄及闭塞的安全性和有效性。
106例有症状的患者（91例男性，15例女性），有67处主要为B型和C型的严重狭窄以及46处慢性闭塞病变。
单纯旋转血管成形术以及联合经皮腔内冠状动脉血管成形术后即刻、24小时及6个月时直径狭窄的平均变化；6个月时的再狭窄率；治疗并发症。
由于无法用旋切导管导丝抵达或穿过病变，5处狭窄和16处慢性闭塞病变无法进行旋转消融。4例旋转消融失败。67处狭窄中的40处（60%）以及46处慢性闭塞病变中的18处（39%）通过旋转消融取得了初始血管造影及临床成功。45例患者接受了额外的球囊血管成形术，成功率分别提高到79%和54%。在通过旋转消融治疗的62处狭窄病变中，单纯旋切导管治疗后血管造影直径狭窄从76%（标准差14%）降至32%（14%），联合球囊血管成形术后从75%（11%）降至33%（17%）。在通过旋转消融治疗的30处慢性闭塞病变中，血管造影直径狭窄降至38%（18%）。6个月时，单纯旋转消融治疗的25处狭窄病变中有9处（36%）出现血管造影再狭窄，旋转消融联合球囊血管成形术治疗的22处狭窄病变中有7处（32%）出现再狭窄，24处慢性闭塞病变中有14处（58%）出现再狭窄。无手术死亡病例，2例患者（2%）接受了急诊冠状动脉搭桥术。虽然未发生透壁性心肌梗死，但有5例（6%）非Q波心肌梗死（2例栓塞性侧支闭塞、2例亚急性闭塞和1例急性闭塞）。5例患者（6%）肌酸激酶活性出现临床上无显著意义的轻微升高。7例（8%）出现对药物治疗无反应的严重冠状动脉痉挛。
高频旋转消融术是治疗B型和C型冠状动脉病变的一种安全有效的方法，其结果与经皮腔内冠状动脉球囊血管成形术相当。旋转消融与球囊血管成形术联合应用是可行的，在大约一半的手术中是必要的，大多数情况下是因为最大的磨头所形成的管腔过小。
