摘要
目的:分析经皮冠状动脉介入治疗(PCI)术后支架膨胀不全、支架内再狭窄、支架变形、支架损毁、导丝嵌顿等原因下行冠状动脉支架内旋磨术的安全性.方法:纳入 2016～2022 年国内 7 家大型心脏中心因上述原因行冠状动脉支架内旋磨术的冠心病患者共 19 例,回顾性收集其基线资料、术中资料、手术并发症、住院期间手术相关不良事件(4a型心肌梗死、急诊冠状动脉旁路移植术和全因死亡)及出院后随访期间主要不良心血管事件(MACE,包括靶血管再次血运重建、脑卒中、全因死亡、再发心肌梗死)发生情况.结果:19 例患者的中位年龄为 70(64,73)岁,男性 13 例,平均左心室射血分数为(56.89±8.76)%.术中采用桡动脉入路 13 例,11 例患者在干预期间仅用 1 个旋磨头,6 例患者使用 2 个旋磨头,2 例患者使用 3 个旋磨头,平均需(7.00±4.23)次旋磨通过病变,19 例患者全部手术成功,即刻管腔获得面积为(1.23±0.78)mm2.旋磨后所有患者均成功置入药物洗脱支架.旋磨术后发生冠状动脉慢血流 1 例,经药物治疗后改善;旋磨头嵌顿 3 例,经操作后成功拔出.术中未发生冠状动脉穿孔、冠状动脉夹层、冠状动脉痉挛、紧急转外科开胸手术、死亡等事件,住院期间也未发生手术相关不良事件.术后随访 3～24 个月,1 例患者接受靶血管再次血运重建,其余患者未发生MACE.结论:本小样本分析结果表明,对于既往PCI术后支架膨胀不全、支架内再狭窄以及即刻PCI术中支架膨胀不全、支架变形、支架损毁、导丝嵌顿等情况,冠状动脉支架内旋磨术是一种可行的选择,手术成功率高,安全性良好,长期随访未发生MACE.
Abstract
Objectives:To analyze the safety of coronary artery stent rotational atherectomy due to stent underexpansion,in-stent restenosis,stent deformation,stent damage,and guide wire entrapment.Methods:A total of 19 patients with coronary artery disease who underwent coronary artery stent rotational atherectomy for the above reasons in 7 large heart centers in China from 2016 to 2022 were collected.Their baseline data,procedure process data,procedural complications,the occurrence of procedure-related adverse events(type 4a myocardial infarction,emergency coronary artery bypass grafting,and all-cause death)during hospitalization and major adverse cardiovascular events(MACE,including target vessel revascularization,stroke,all-cause death,and recurrent myocardial infarction)during post-discharge follow-up were retrospectively collected.Results:The mean age of the 19 patients was 70(64,73)years,and 13 patients were males.The mean left ventricular ejection fraction was(56.89±8.76)%.Radial artery approach was used in 13 patients,11 patients used 1 burr during the intervention period,6 patients used 2 burrs,and 2 patients used 3 burrs.The average times of burr passing through the lesion was(7.00±4.23)times.The surgical success rate was 100%,and the immediate lumen acquired area was(1.23±0.78)mm2.Drug-eluting stents were successfully implanted in all patients after spinning.Coronary slow blood flow occurred in 1 case after rotational grinding,which was improved after drug treatment.The burr was entrapmented in 3 cases and successfully pulled out after operation.No coronary artery perforation,coronary artery dissection,coronary artery spasm,emergency thoracotomy,or death occurred during the operation,and no procedure-related adverse events occurred during hospitalization.During 3 to 24 months of follow-up,1 patient underwent target vessel revascularization,and there were no MACE in other patients.Conclusions:Coronary artery stent rotational atherectomy in patients with stent underexpansion,in-stent restenosis,stent deformation,stent damage,and guide wire entrapment,is a feasible option,with a high surgical success rate and satisfactory safety.None of the patients experienced MACE during long-term follow-up.
基金项目
国家自然科学基金面上项目(82070520)
湖南省人民医院仁术基金重点培育项目(RS2022A04)
NETL
NSTL
万方数据