CAJ | 학술논문

目的评价慢性完全闭塞(CTO)病变介入治疗中,在导丝通过病变但球囊无法通过的情况下,冠状动脉斑块旋磨术对CTO病变开通率和疗效的影响.方法入选2008年8月至2012年12月对冠状动脉CTO病变行介入治疗的患者.导丝通过CTO病变后,球囊无法通过病变者分入旋磨术组(行冠状动脉斑块旋磨术,共26例患者,27处病变)；球囊可以通过病变者分入对照组(共751例患者,751处病变).球囊通过CTO病变后,两组均置入药物洗脱支架.观察冠状动脉斑块旋磨术成功率和住院期间主要不良心血管事件(包括心原性死亡、介入治疗相关心肌梗死和靶血管血运重建)的发生率.结果术前冠状动脉造影显示,旋磨术组CTO病变处重度钙化的比例高于对照组[63.0％ (17/27)比21.2％(159/751),P＜0.05].行冠状动脉斑块旋磨术后,旋磨术组的27处CTO病变中有25处(92.6％)病变成功开通.旋磨术组与对照组之间住院期间心原性死亡[0比0.5％(4/751),P＞0.05]、介入治疗相关心肌梗死[38.5％ (10/26)比22.2％(167/751),P＞0.05]和靶血管血运重建[0比1.2％(9/751),P＞0.05]的比例差异均无统计学意义.结论冠状动脉斑块旋磨术有助于提高导丝通过后球囊无法通过的CTO病变的手术成功率.
목적 평개만성완전폐새(CTO)병변개입치료중,재도사통과병변단구낭무법통과적정황하,관상동맥반괴선마술대CTO병변개통솔화료효적영향.방법 입선2008년8월지2012년12월대관상동맥CTO병변행개입치료적환자.도사통과CTO병변후,구낭무법통과병변자분입선마술조(행관상동맥반괴선마술,공26례환자,27처병변)；구낭가이통과병변자분입대조조(공751례환자,751처병변).구낭통과CTO병변후,량조균치입약물세탈지가.관찰관상동맥반괴선마술성공솔화주원기간주요불양심혈관사건(포괄심원성사망、개입치료상관심기경사화파혈관혈운중건)적발생솔.결과 술전관상동맥조영현시,선마술조CTO병변처중도개화적비례고우대조조[63.0％ (17/27)비21.2％(159/751),P＜0.05].행관상동맥반괴선마술후,선마술조적27처CTO병변중유25처(92.6％)병변성공개통.선마술조여대조조지간주원기간심원성사망[0비0.5％(4/751),P＞0.05]、개입치료상관심기경사[38.5％ (10/26)비22.2％(167/751),P＞0.05]화파혈관혈운중건[0비1.2％(9/751),P＞0.05]적비례차이균무통계학의의.결론 관상동맥반괴선마술유조우제고도사통과후구낭무법통과적CTO병변적수술성공솔.
Objective To assess the application of rotational atherectomy to improving the success rate and outcome of percutaneous recanalization of resistant chronic total occlusion (CTO),i.e.the guidewire could cross the lesion but it is impossible to advance any device over the wire through the occluded segment.Methods From August 2008 to December 2012,26 consecutive patients with 27 resistent CTO lesions were additionally treated by high-speed rotational atherectomy (rotational atherectomy group).The control group included 751 non-resistent CTO lesions.Drug-eluting stents were implanted in two groups after the balloon catheter crossed the CTO lesions.The successful rate of rotational atherectomy and in hospital major adverse cardiovascular events (including cardiac death,interventional treatment related myocardial infarction and target vessel revascularization) were observed.Results The rate of heavily calcified coronary lesions was significantly higher in rotational atherectomy group than in the control group [63.0％ (17/27) vs.21.2％ (159/751),P ＜0.05] according to pre-procedural coronary angiography.Rotational atherectomy was successful in 25 out of 27 resistant CTO lesions (92.6 ％).The rate of cardiac death [0 vs.0.5％ (4/751),P ＞ 0.05],interventional treatment related myocardial infarction [38.5％ (10/26) vs.22.2％ (167/751),P ＞ 0.05] and target vessel revascularization [0 vs.1.2％ (9/751),P ＞ 0.05] were similar between the rotational atherectomy group and the control group.Conclusion Rotational atherectomy is a safe and helpful technique to overcome the inability of balloon catheter to cross a resistant CTO.