南方医科大学学报

南方医科大学学报 ›› 2021, Vol. 41 ›› Issue (7): 1044-1049.doi: 10.12122/j.issn.1673-4254.2021.07.11

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血管内超声指导下的旋磨术联合切割球囊预处理冠状动脉重度钙化病变：120例前瞻性随机对照试验

韩风杰，郑海军，郑献召，晋 辉，王中明，曾 辉，邱翠婷，刘 静，朱艳霞   

  • 出版日期:2021-07-20 发布日期:2021-07-16

Efficacy of intravascular ultrasound-guided rotational atherectomy combined with cutting balloon for pretreatment of severe coronary artery calcified lesions

  • Online:2021-07-20 Published:2021-07-16

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摘要： 目的 探讨血管内超声（IVUS）指导下冠脉旋磨术（RA）联合切割球囊（CB）预处理冠状动脉重度钙化病变的的疗效及安全性。方法 2016年1月~2019年1月在我院选取经IVUS检查出冠状动脉重度钙化病变且需行冠脉介入（PCI）的患者120例。按照数字表法随机分为两组，在PCI前分别给予不同的预处理方案：SB组[RA+普通半顺应性球囊（SB），60例]和CB组（RA+CB，60例）。预处理后均置入药物洗脱支架。比较两组患者的即刻PCI成功率、PCI术后IVUS检测指标（最小支架内管腔直径、最小支架内管腔横截面积、管腔横截面积残余狭窄程度、即刻管腔直径获得、即刻管腔横截面积获得），统计病变残余狭窄<10%的优良率，随访术中并发症及术后24月主要不良心脏事件（MACE）。结果 CB组患者的手术即刻成功率高于SB组（P=0.032）；预处理及支架置入后，CB组患者的最小支架内管腔直径（P=0.035）、最小支架内管腔横截面积（P=0.029）、即刻管腔获得、即刻管腔横截面积获得及病变残余狭窄<10 %的优良率均明显大于SB组（P<0.001），CB组患者的管腔横截面积残余狭窄程度轻于SB组（χ2=7.859，P=0.005）；CB组患者的术中并发症发生率（χ2=5.997，P=0.014）及术后24月MACE发生率均低于SB组（χ2=4.285，P=0.038）。结论 对适合PCI的冠状动脉重度钙化病变实施RA+CB，可明显提高即刻PCI成功率，扩大PCI术后支架内管腔直径及横截面积，即刻管腔获得显著，降低术中并发症及术后24个月MACE发生率，改善患者预后。

关键词: 冠状动脉钙化；旋磨术；切割球囊；半顺应性球囊；血管内超声

Abstract: Objective To investigate the efficacy and safety of intravascular ultrasound (IVUS)- guided rotational atherectomy (RA) combined with cutting balloon for pretreatment of severe calcified lesions in the coronary artery before stent placement. Methods A total of 120 patients with severe coronary artery calcifications detected by IVUS that required percutaneous coronary intervention (PCI) were recruited from our hospital between January, 2016 to January, 2019. The patients were randomized into two groups for pretreatment of the lesions with semicompliant balloon (SB group, 60 cases) or RA combined with CB (RA+CB group, 60 cases), and drug-eluting stents were implanted after the procedure. The immediate success rate of PCI, vascular parameters detected by IVUS after PCI, and the rates of residual stenosis <10% were compared between the two groups. The incidences of intraoperative complications and major adverse cardiac events (MACE) within 24 months after the surgery were also observed in the two groups. Results The immediate success rate was significantly higher in RA+CB group than in SB group (P=0.032). After pretreatment and stent placement, the minimum stent lumen diameter (P=0.035), minimum stent lumen cross-sectional area (P=0.029), immediate lumen acquisition, immediate lumen cross-sectional area acquisition and the rate of residual stenosis <10% were all significantly higher in RA+CB group than in SB group (P<0.001). The patients in RA+CB group showed obviously less residual stenosis of lumen cross-sectional area than those in SB group after the surgery (χ2= 7.859, P=0.005). The incidences of intraoperative complications (χ2=5.997, P=0.014) and MACE within 24 months after the operation (χ2=4.285, P=0.038) were significantly lower in RA+CB group than in SB group. Conclusion For patients with severe coronary artery calcifications eligible for PCI, RA combined with CB angioplasty can significantly improve the success rate of immediate PCI, expand the lumen diameter and cross-sectional area of the stent after PCI, enhance immediate lumen gain, and reduce the incidence of intraoperative complications and MACE after the operation.

Key words: coronary artery calcification; rotational atherectomy; cutting balloon; semicompliant balloon; intravascular ultrasound