Hoffmann R, Mintz G S, Popma J J, Satler L F, Kent K M, Pichard A D, Leon M B
Intravascular Ultrasound Imaging and Cardiac Catheterization Laboratories, Washington Hospital Center, Washington, DC, USA.
Eur Heart J. 1998 Aug;19(8):1224-31. doi: 10.1053/euhj.1998.1028.
To evaluate the result of coronary stenting in calcified lesions and to find morphological and procedural factors influencing the final result.
Three hundred and twenty three native coronary artery lesions in 303 patients (197 men, mean age 63.9 +/- 11.5 years) treated with Palmaz-Schatz stents were differentiated into four groups depending on their degree of circumferential calcification as defined by intravascular ultrasound [0-90 degrees (n=120), 91-180 degrees (n=58, 181-270$ (n=71) and 271-360 degrees n=74)]. In 117 lesions rotational atherectomy was used prior to stent placement. Intravascular ultrasound and quantitative angiography were performed prior to treatment and after stent placement to measure minimal and maximal lumen diameter and lumen cross-sectional area at the lesion site and the reference segments. Acute lumen gain and eccentricity index were calculated. Although higher balloon pressures were used than in the minimally calcified lesions. the final angiographic minimal lumen diameter decreased with increasing arc of calcification (3.01 +/- 0.47, 3.04 +/- 0.43, 2.85 +/- 0.53, 2.83 +/- 0.40 mm, respectively, P=0.0320) resulting in a decrease in acute diameter gain with increasing arc of calcification (2.06 +/- 0.51, 1.91 +/- 0.46, 1.81 +/- 0.56, 1.78 +/- 0.51 mm, respectively, P=0.0067). Adjunctive rotational atherectomy prior to stent placement resulted in a greater acute diameter and a greater lumen cross-sectional area gain, coupled with less final residual stenosis than pre-treatment with balloon angioplasty.
Implantation of stents in calcified lesions results in less optimal stent expansion, especially in lesions with thick, eccentric calcific plaque layers. Use of adjunctive rotational atherectomy before stent placement may improve the procedural result.
评估冠状动脉钙化病变支架置入的效果，并找出影响最终结果的形态学和操作因素。
303例患者（197例男性，平均年龄63.9±11.5岁）的323处冠状动脉原位病变接受了帕尔马兹-沙茨支架治疗，根据血管内超声定义的圆周钙化程度分为四组[0 - 90度（n = 120）、91 - 180度（n = 58）、181 - 270度（n = 71）和271 - 360度（n = 74）]。117处病变在支架置入前使用了旋磨术。在治疗前和支架置入后进行血管内超声和定量血管造影，以测量病变部位和参考节段的最小和最大管腔直径以及管腔横截面积。计算急性管腔增加量和偏心指数。尽管与轻度钙化病变相比使用了更高的球囊压力，但最终血管造影最小管腔直径随钙化弧增加而减小（分别为3.01±0.47、3.04±0.43、2.85±0.53、2.83±0.40 mm，P = 0.0320），导致急性直径增加量随钙化弧增加而减小（分别为2.06±0.51、1.91±0.46、1.81±0.56、1.78±0.51 mm，P = 0.0067）。支架置入前辅助旋磨术导致更大的急性直径增加量和更大的管腔横截面积增加量，且最终残余狭窄比球囊血管成形术预处理时更少。
钙化病变中支架置入导致支架扩张效果欠佳，尤其是在具有厚的、偏心钙化斑块层的病变中。在支架置入前使用辅助旋磨术可能改善操作结果。
