Stertzer S H, Pomerantsev E V, Fitzgerald P J, Shaw R E, Walton A S, Singer A H, Yeung A, Yock P G, Oesterle S N
Stanford University, Division of Cardiovascular Medicine, California 94304, USA.
Cathet Cardiovasc Diagn. 1995 Dec;36(4):304-10. doi: 10.1002/ccd.1810360404.
Seven hundred ten high speed rotational atherectomy (HSRA) procedures were performed in a single consecutive series of 656 patients. Stand alone HSRA was performed in 253 patients (35%). HSRA with adjunctive low pressure (< or = 2 ATM) balloon angioplasty (LP BA) was performed in 221 patients (31%), and HSRA with adjunctive high pressure (> or = 4 ATM) balloon angioplasty (HP BA) was performed in 236 patients (34%). Prognostically unfavorable Type B2 and C lesions dominated the study group (74.7%). Procedural success rate was 96%. Emergency coronary artery bypass surgery was performed in 1.4% of cases, Q wave myocardial infarction occurred in 3.4% and death, related to procedure, was consequent in 0.5% of cases. Incidence of flow limiting dissections was 3.1%, distal spasm was 5.3%, and "no reflow" phenomenon was 1.8%. The recent technique modifications included continuous advancer/guiding catheter infusion of the nitroglycerin-verapamil mixture, limitation of duration of lesion engagement by the burr, stepwise increase in the burr size, decrease of rotational speed, and strict control of rpm drop during lesion ablation. Evolution of the interventional technique involved trends towards decrease of the use of HP BA in conjunction with steady increase in the percentage of SA and LP BA procedures over time. These technique changes resulted in complete absence of "no reflow" in 1994, as well as a generalized decrease in overall coronary vascular reactivity from all burr passes.
在连续的656例患者中进行了710例高速旋磨术（HSRA）。253例患者（35%）仅接受了HSRA。221例患者（31%）接受了HSRA联合低压（≤2个大气压）球囊血管成形术（LP BA），236例患者（34%）接受了HSRA联合高压（≥4个大气压）球囊血管成形术（HP BA）。预后不良的B2型和C型病变在研究组中占主导地位（74.7%）。手术成功率为96%。1.4%的病例进行了急诊冠状动脉搭桥手术，3.4%发生了Q波心肌梗死，0.5%的病例因手术相关死亡。血流限制性夹层的发生率为3.1%，远端痉挛为5.3%，“无复流”现象为1.8%。最近的技术改进包括连续通过推进器/引导导管输注硝酸甘油-维拉帕米混合物、限制磨头与病变接触的时间、逐步增加磨头尺寸、降低旋转速度以及在病变消融期间严格控制转速下降。介入技术的发展趋势是随着时间的推移，HP BA的使用减少，SA和LP BA手术的百分比稳步增加。这些技术变化导致1994年完全没有“无复流”现象，并且所有磨头通过后的总体冠状动脉血管反应性普遍降低。
