Rotational atherectomy versus balloon pre-dilated for treating heavily calcified coronary lesions
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Department of Cardiology, Fuyang People's Hospital & Fuyang Clinical College of Anhui Medical University, Fuyang, Anhui 236000, China)

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R543.3

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    Abstract:

    Aim To study the efficacy of rotational atherectomy (RA) versus balloon pre-dilated combined with drug eluting stent(DES) implatation in the treatment of heavily calcified coronary lesions. Methods The study selected patients with heavily calcified coronary lesions admitted in Fuyang City People's Hospital from October 2017 to October 2018 who were going to receive PCI. The patients were divided into two groups according to the random number table, which were the RA combined with DES group (observation group, n=32) and the balloon pre-dilated combined with DES(control group, n=40). Prospective randomized controlled study was performed. The treatment characteristics and perioperative complications were compared between the two groups. The risk factors of major adverse cardiovascular and cerebrovascular events (MACCE) within 6 months were analyzed. Results The average stent diameter was significantly higher in the observation group than in the control group (3.25 (3.0,3.50) mm vs 3.00 (2.1,3.25) mm, P=0.002). The number of balloon pre-dilated,pre-dilated maximum pressure, the number of balloon post-dilated and post-dilated maximum pressure were significantly lower in the observation group than in the control group(P<0.05). The lumen diameter after PCI was significantly larger in the observation group than in the control group((3.34±0.28) mm vs (3.15±0.27) mm, P=0.005). The procedural success rate of the observation group (96.9%) was higher than that of the control group (92.9%), the incidence of total MACCE in the observation group (9.4%) was lower than in the control group (22.5%), but there is no significant differences between the two groups(P>0.05). The previous PCI(risk ration:1.5,5%CI:0.030~0.691, P=0.015) and the maximum pressure of balloon pre-dilated(risk ration:2.6,5%CI:0.721~0.988, P=0.035) were independent risk factors for MACCE within 6 months. Conclusions For severely calcified coronary lesions with a SYNTAX score of 23 to 32, RA has tendencies to improve the procedural success rate and reduce short-term adverse events. The previous PCI and the maximum pressure of pre-dilated were independent risk factors for MACCE within 6 months.

    Reference
    [1] Kuriyama N, Kobayashi Y, Yamaguchi M, et al.Usefulness of rotational atherectomy in preventing polymer damage of everolimus-eluting stent in calcified coronary artery.JACC Cardiovas Interv, 1,4(5):588-589.
    [2] Chen YW, Su CS, Chang WC, et al.Feasibility and clinical outcomes of rotational atherectomy for heavily-calcified side branches of complex coronary bifurcation lesions in the real-world practice of the drug-eluting stent era.J Interv Cardiol, 8,1(4):486-495.
    [3] Tian W, Mahmoudi M, Lhermusier T, et al.Clinical outcomes of first- and second-generation drug-eluting stents in patients undergoing rotational atherectomy for heavily calcified coronary lesions.Cardiovasc Revasc Med, 5,6(3):147-150.
    [4] Abdel-Wahab M, Richardt G, Joachim Büttner H, et al.High-speed rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions.JACC Cardiovas Interv, 3,6(1):10-19.
    [5] 葛均波, 王伟民, 霍勇.冠状动脉内旋磨术中国专家共识.中国介入心脏病学杂志, 7,5(2):61-66.
    [6] Tian W, Lhermusier T, Minha S, et al.Rational use of rotational atherectomy in calcified lesions in the drug-eluting stent era:Review of the evidence and current practice.Cardiovasc Revasc Med, 5,6(2):78-83.
    [7] de Waha S, Allali A, Büttner HJ, et al.Rotational atherectomy before paclitaxel-eluting stent implantation in complex calcified coronary lesions:Two-year clinical outcome of the randomized ROTAXUS trial.Catheter Cardiovasc Interv, 6,7(4):691-700.
    [8] 徐承义, 曾秋棠, 苏晞, 等.冠状动脉完全闭塞病变不同时间窗经皮冠状动脉介入治疗回顾性分析.中国心血管杂志, 6,1(5):368-374.
    [9] Jiang J, Sun Y, Xiang MX, et al.Complex coronary lesions and rotational atherectomy:one hospital's experience.Zhejiang Univ Sci B, 2,3(8):645-651.
    [10] Tanigawa J, Barlis P, Di Mario C.Heavily calcified coronary lesions preclude strut apposition despite high pressure balloon dilatation and rotational atherectomy:in-vivo demonstration with optical coherence tomography.Circulation, 7,2(1):157-160.
    [11] 黄吟雪, 张磊.SNYTAX积分对冠心病治疗指导作用的研究现状.心血管病学进展, 7,8(5):600-604.
    [12] Serruys PW, Onuma Y, Garg S, et al.Assessment of the SYNTAX score in the Syntax study.Euro Intervention, 9,5(1):50-56.
    [13] 吴铮, 郑泽, 柳景华.冠状动脉旋磨术联合药物洗脱支架治疗冠状动脉重度钙化病变的效果与安全性.中国综合临床, 8,4(1):15-20.
    [14] 张慧平, 赵迎, 郑耐心, 等.补救性旋磨技术在冠状动脉钙化病变中的应用分析.中国介入心脏病学杂志, 8,6(9):510-516.
    [15] Barbato E, Carrié D, Dardas P, et al.European expert consensus on rotational atherectomy.Euro Intervention, 5,1(1):30-36.
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LV Mingzhi, NING Bin. Rotational atherectomy versus balloon pre-dilated for treating heavily calcified coronary lesions[J]. Editorial Office of Chinese Journal of Arteriosclerosis,2020,28(4):344-349.

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History
  • Received:June 18,2019
  • Revised:July 22,2019
  • Online: April 27,2020
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