CAJ | 학술논문

　　目的探讨冠状动脉（简称“冠脉”）旋磨术联合药物洗脱长支架用于治疗严重冠脉钙化病变的安全性及有效性。方法入选2010年1月至12月因严重冠脉钙化而行冠脉旋磨术联合药物洗脱长支架植入治疗的患者。观察患者的手术成功率，围术期并发症及术后主要心血管事件（包括心源性死亡、心肌梗死、靶病变血运重建）的发生率。结果共21例严重冠脉钙化病变患者接受了冠脉旋磨术联合药物洗脱长支架植入治疗，年龄（65.2±6.9）岁。合并高血压病16例（76.2%），糖尿病7例（33.3%），肾功能不全1例（4.8%）。旋磨部位共植入35枚国产药物支架（1.75枚/部位），最短支架长度为28mm，病变部位平均支架总长度为48（29～66）mm，仅1例因旋磨头未能通过病变而放弃，手术成功率为95.2%（20/21）。术中1例出现冠脉痉挛，1例出现胸痛伴心率减慢；术后1例出现消化道出血。住院期间无心血管事件发生，平均随访26个月，仅1例（4.8%）患者于术后第2个月发生急性心肌梗死，余患者病情稳定。结论冠脉旋磨术联合药物洗脱长支架植入术治疗严重冠脉钙化病变可取得很高的手术成功率，是治疗钙化病变安全、有效的方法。
　　목적탐토관상동맥（간칭“관맥”）선마술연합약물세탈장지가용우치료엄중관맥개화병변적안전성급유효성。방법입선2010년1월지12월인엄중관맥개화이행관맥선마술연합약물세탈장지가식입치료적환자。관찰환자적수술성공솔，위술기병발증급술후주요심혈관사건（포괄심원성사망、심기경사、파병변혈운중건）적발생솔。결과공21례엄중관맥개화병변환자접수료관맥선마술연합약물세탈장지가식입치료，년령（65.2±6.9）세。합병고혈압병16례（76.2%），당뇨병7례（33.3%），신공능불전1례（4.8%）。선마부위공식입35매국산약물지가（1.75매/부위），최단지가장도위28mm，병변부위평균지가총장도위48（29～66）mm，부1례인선마두미능통과병변이방기，수술성공솔위95.2%（20/21）。술중1례출현관맥경련，1례출현흉통반심솔감만；술후1례출현소화도출혈。주원기간무심혈관사건발생，평균수방26개월，부1례（4.8%）환자우술후제2개월발생급성심기경사，여환자병정은정。결론관맥선마술연합약물세탈장지가식입술치료엄중관맥개화병변가취득흔고적수술성공솔，시치료개화병변안전、유효적방법。
Objective To assess the safety and efficiency of long-term outcome after rotational atherectomy (RA) followed by long drug-eluting stent (DES) implantation in severe calcified coronary lesions. Methods Patients with severe calcified coronary lesions treated with RA followed by long DES in our department between January and December 2010 were enrolled. Their procedural success rate, preoperative complications, and postoperative major adverse cardiovascular events (MACE, including cardiac death, myocardial infarction and target lesion revascularization) were recorded and analyzed. All patients were available for our long-term follow-up. Results Twenty-one patients with complex calcified coronary lesions were treated with RA followed by long DES, with age of (65.2±6.9)years. There were 16 patients (76.2%) having hypertension, 7 (33.3%) having diabetes mellitus and 1 (4.8%) having chronic renal failure. There were totally 35 stents implantated in 20 calcified coronary lesions (1.75 per lesion). One patient did not finish the operation due to the drill head could not go through the lesion. The overall procedure success rate was 95.2%(20/21). The shortest length of the implanted stent was 28 mm, and the average length of total stent /lesions was 48 mm (ranging from 29 to 66 mm). The preoperative complications included 1 case of coronary spasm, and 1 case of chest pain with decreased heart rate, and the postoperative complication only had 1 case of gastrointestinal bleeding. There was no patient having the incidence of in-hospital MACE. During a median follow-up period of 26 months (ranging 20 to 31 months), only 1 patient (4.8%) had acute myocardial infarction at 1 month after operation, and the other were in stable sound condition. Conclusion RA followed by long DES implantation appears to be feasible and effective in treatment of complex calcified coronary lesions, with a high rate of procedural success and low incidence of MACE in a long-term period.