冠状动脉腔内旋磨术联合药物洗脱支架治疗极度严重钙化病变的短中期疗效

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目的:评价冠状动脉腔内旋磨术联合药物洗脱支架术治疗极度严重钙化病变的短中期疗效。方法:对12例极度严重钙化病变常规经皮冠脉介入治疗(PCI)失败或预期不能实施的冠心病患者实施冠脉内旋磨并植入药物洗脱支架,观察其治疗的即刻疗效及6个月的随访结果。结果:冠脉内旋磨术的12例患者,其中8例常规PCI治疗失败:2例球囊无法通过病变,3例球囊不能扩张,3例球囊扩张后支架无法通过;4例极度严重钙化预期不能实施常规PCI治疗,12例患者均成功实施冠脉内旋磨术,3例新发生夹层形成,3例出现慢血流,旋磨后11例以低压[小于6 atm(1 atm=101.325 kPa)]充分扩张病变,仅1例需高压(28 atm)扩张病变,1例在术中发生心原性休克,植入主动脉内球囊反博(IABP)后完成手术;无1例发生冠脉穿孔、死亡、急性心肌梗死及急诊冠脉旁路移植术(CABG),所有病例支架均顺利通过病变并实施扩张术。对12例患者进行了术后6个月的冠脉造影随访,有1例发生支架内再狭窄。结论:对常规介入治疗失败或预期难以实施常规介入治疗的极度严重钙化病变,冠脉内旋磨预处理后均能完成支架植入术,旋磨后植入药物洗脱支架短中期疗效良好。 OBJECTIVE: To evaluate the short-term and long-term effects of intraluminal rotational atherectomy combined with drug-eluting stents in the treatment of the severely calcified lesions. Methods: Twelve patients with coronary heart disease who failed or were expected to be impaired by routine percutaneous coronary intervention (PCI) with severe calcification were treated with coronary revascularization and drug-eluting stents. The immediate curative effect and Months of follow-up results. RESULTS: Twelve patients undergoing coronary revascularization failed in 8 of the conventional PCI procedures: 2 had failed balloon occlusion, 3 had balloon dilatation, 3 had balloon dilatation, and 4 had extremely severe Calcification is not expected to be implemented PCI, 12 patients were successfully implemented coronary rotation surgery, 3 cases of new dissection, slow blood flow in 3 cases, 11 cases of rotational at low pressure [less than 6 atm (1 atm = 101.325 kPa)], only one case required high-pressure (28 atm) dilatation, one had cardiogenic shock during operation, and the procedure was completed after intra-aortic balloon catheterization (IABP); none Coronary perforation, death, acute myocardial infarction, and emergency coronary artery bypass grafting (CABG) occurred. All cases were successfully treated with lesions and dilated. Twelve patients were followed up for 6 months after coronary angiography, and one case had in-stent restenosis. CONCLUSIONS: For the severely calcified lesions, which failed or are difficult to be routinely involved in conventional interventional therapy, stent implantation can be performed after intracoronary rotation pre-treatment. The effect of implanting the drug-eluting stent in short to medium term is good.
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