Hoffmann R, Mintz G S, Kent K M, Pichard A D, Satler L F, Popma J J, Hong M K, Laird J R, Leon M B
Department of Internal Medicine, Washington Hospital Center, Washington, DC 20010, USA.
Am J Cardiol. 1998 Mar 1;81(5):552-7. doi: 10.1016/s0002-9149(97)00983-1.
The aim of this study was to determine the preferred treatment modality for calcified lesions in large (> or = 3 mm) coronary arteries, resulting in the largest lumen dimensions and the most favorable late clinical responses. Three hundred six lesions in 306 patients (223 men, mean age 66 +/- 11 years) were treated with either rotational atherectomy plus adjunct balloon angioplasty (n = 147), Palmaz-Schatz stents (n = 103), or a combination of rotational atherectomy plus adjunct Palmaz-Schatz stents (n = 56). The procedural success rate was 98.0% to 98.6% for each treatment modality. Minimal lumen diameter (MLD) before therapy was similar for all therapies. Final MLD after combination of rotational atherectomy plus Palmaz-Schatz stents was larger than after stent therapy or rotational atherectomy plus balloon angioplasty (3.21 +/- 0.49 mm, 2.88 +/- 0.51 mm, and 2.29 +/- 0.55 mm, respectively, p <0.0001). Correspondingly, final percent diameter stenosis was lowest after the combination of rotational atherectomy plus stent therapy, and significantly higher for stents or rotational atherectomy plus balloon angioplasty (4.2 +/- 15.3%, 14.1 +/- 13.3%, and 26.7% +/- 16.9%, respectively, p <0.0001). Event-free survival at 9 months was higher for patients treated with the combination of rotational atherectomy plus stents than either stent therapy or rotational atherectomy alone (85%, 77%, and 67%, respectively, log-rank p = 0.0633). The only significant independent predictor of an event during the 9-month follow-up period was the MLD after intervention (odds ratio 0.495, 95% confidence interval 0.308 to 0.796, p = 0.0037). We conclude that preatheroablation using rotational atherectomy, followed by adjunct stent placement for calcified lesions in large arteries, is associated with infrequent complications, the largest acute angiographic results, and the most favorable late clinical event rates.
本研究的目的是确定针对大口径（≥3毫米）冠状动脉钙化病变的首选治疗方式，以实现最大的管腔尺寸和最有利的晚期临床反应。306例患者（223例男性，平均年龄66±11岁）的306处病变，分别接受了旋磨术联合辅助球囊血管成形术（n = 147）、Palmaz-Schatz支架置入术（n = 103）或旋磨术联合辅助Palmaz-Schatz支架置入术（n = 56）治疗。每种治疗方式的手术成功率为98.0%至98.6%。所有治疗方法治疗前的最小管腔直径（MLD）相似。旋磨术联合Palmaz-Schatz支架置入术后的最终MLD大于单纯支架治疗或旋磨术联合球囊血管成形术后的MLD（分别为3.21±0.49毫米、2.88±0.51毫米和2.29±0.55毫米，p<0.0001）。相应地，旋磨术联合支架治疗后的最终直径狭窄百分比最低，而单纯支架治疗或旋磨术联合球囊血管成形术的则显著更高（分别为4.2±15.3%、14.1±13.3%和26.7%±16.9%，p<0.0001）。旋磨术联合支架治疗的患者9个月时的无事件生存率高于单纯支架治疗或单纯旋磨术治疗的患者（分别为85%、77%和67%，对数秩检验p = 0.0633）。9个月随访期内事件的唯一显著独立预测因素是干预后的MLD（优势比0.495，95%置信区间0.308至0.796，p = 0.0037）。我们得出结论，对于大动脉钙化病变，先采用旋磨术进行粥样斑块切除术，随后辅助置入支架，并发症发生率低，急性血管造影结果最佳，晚期临床事件发生率最有利。
