Kiesz R S, Rozek M M, Mego D M, Patel V, Ebersole D G, Chilton R J
Department of Medicine, University of Texas Health Science Center, South Texas Veteran Health System, Audie Murphy Division, San Antonio 78284-7872, USA.
Cathet Cardiovasc Diagn. 1998 Oct;45(2):105-12. doi: 10.1002/(sici)1097-0304(199810)45:2<105::aid-ccd1>3.0.co;2-g.
The purpose of this study was to determine the results of directional coronary atherectomy (DCA) combined with stenting in a high-risk patient population. The use of stenting or DCA alone for aorto-ostial lesions, total chronic occlusions, long lesions, and lesions containing thrombus is associated with lowered success and a relatively high restenosis rate. Between July 1993 and October 1996, we treated 89 lesions with the combined approach of DCA and stenting in 60 consecutive patients. Thirty-one (51.7%) patients were treated because of unstable angina, 11 (18.3%) for post-myocardial infarction (MI) angina, 3 (5.0%) for acute MI, and 15 (25.0%) patients for stable angina. A total of 43 (71.7%) patients had multivessel disease, 19 (31.7%) had undergone previous coronary artery bypass graft (CABG), and 17 (28.3%) patients had undergone multivessel revascularization. The procedure was successful in all patients; and no postprocedural deaths or emergent CABG occurred. Two patients (3.3%) had non-Q-wave MI after the procedure and 1 patient (1.7%) experienced Q-wave MI due to subacute stent closure 7 days after the procedure. During follow-up ranging from 6 months to 3 years, 2 (3.3%) patients died, 2 (3.3%) required CABG surgery, 1 (1.7%) patient had an MI, and 6 patients (10.0%) required target vessel revascularization. By the quantitative coronary angiography, the initial minimal luminal diameter (MLD) averaged 0.91+/-0.45 mm (74.7+/-11.8% stenosis) increasing to 3.80+/-0.44 mm (-6.7+/-12.1%) after the combined approach procedure. Thirty patients (50.0%) met criteria for late (> or =6 months) angiographic follow-up. Late MLD loss averaged 1.13+/-1.07 mm, for a mean net gain of 1.61+/-1.23 mm. Available angiographic follow-up evaluation showed a restenosis rate of 13.3%. A combined approach, defined as the use of both DCA and stenting, is safe and yields a low restenosis rate in high-risk patients who have lesions known to respond less favorably to stenting or DCA alone.
本研究的目的是确定在高危患者群体中定向冠状动脉斑块旋切术（DCA）联合支架置入术的效果。单独使用支架置入术或DCA治疗主动脉开口病变、完全慢性闭塞病变、长病变以及含血栓病变，成功率较低且再狭窄率相对较高。1993年7月至1996年10月，我们采用DCA与支架置入术联合的方法，连续治疗了60例患者的89处病变。31例（51.7%）患者因不稳定型心绞痛接受治疗，11例（18.3%）因心肌梗死后（MI）心绞痛接受治疗，3例（5.0%）因急性MI接受治疗，15例（25.0%）患者因稳定型心绞痛接受治疗。共有43例（71.7%）患者患有多支血管病变，19例（31.7%）曾接受过冠状动脉旁路移植术（CABG），17例（28.3%）患者接受过多支血管血运重建术。所有患者手术均成功；术后无死亡病例或急诊CABG发生。2例患者（3.3%）术后发生非Q波MI，1例患者（1.7%）术后7天因亚急性支架闭塞发生Q波MI。在6个月至3年的随访期间，2例（3.3%）患者死亡，2例（3.3%）需要行CABG手术，1例（1.7%）患者发生MI，6例（10.0%）患者需要进行靶血管血运重建。通过定量冠状动脉造影，联合手术前初始最小管腔直径（MLD）平均为0.91±0.45 mm（狭窄74.7±11.8%），联合手术后增加至3.80±0.44 mm（-6.7±1%）。30例（50.0%）患者符合晚期（≥6个月）血管造影随访标准。晚期MLD丢失平均为1.13±1.07 mm，平均净增加1.61±1.23 mm。可获得的血管造影随访评估显示再狭窄率为13. %。DCA与支架置入术联合的方法，即同时使用DCA和支架置入术，对于病变对单独的支架置入术或DCA反应较差的高危患者来说是安全的，且再狭窄率较低。 12.1
