Objective: To investigate the safety and efficacy of rotational atherectomy in the interventional treatment of coronary chronic total occlusion lesions. Methods: In this retrospective study,a total of 31 consecutive patients with coronary chronic total occlusion(CTO) lesions underwent rotational atherectomy in our hospital from February 2004 to December 2016 were enrolled,and the clinical features were analyzed. Coronary atherectomy was performed if balloon failed to cross the CTO lesions or balloon could not be fully dilated in the CTO lesions after wire crossing. The definition of procedure success was defined as residual stenosis less than 20% after implantation of drug eluting stent and rotational atherectomy. After the procedure, the patients were followed up to observe major adverse cardiac and cerebral vascular events which including cardiogenic death, myocardial infarction, cerebrovascular accident, and target lesion revascularization. Results: The 1.25 mm diameter burr was firstly selected in 80.6% (25/31) patients,and 96.8%(30/31) patients used only 1 burr to complete the rotational atherectomy procedure. The complication rate was 9.8% (3/31) including 1 patient with coronary dissection and 3 patients with slow flow or no flow. There was 1 patent with both coronary dissection and slow flow. The procedure success rate was 96.8%(30/31). Interventional treatment related myocardial infarction occurred in 3 patients during hospitalization.The 30 patients with procedure success were followed up 36(11, 96) months. The incidence rate of major adverse cardiac and cerebral vascular events was 13.3% (4/30), of which the cardiogenic death rate was 3.3% (1/30), the myocardial infarction rate was 6.7% (2/30), cerebrovascular accident rate was 3.3%(1/30),and the target lesion revascularization rate was 6.7% (2/30). Conclusion: Rotational atherectomy is safe and effective in the interventional treatment of coronary CTO lesions.
目的： 冠状动脉内旋磨术在慢性完全闭塞病变介入治疗中应用的安全性和有效性。 方法： 采用回顾性研究方法，连续入选2004年2月至2016年12月在复旦大学附属中山医院行冠状动脉内旋磨术的冠状动脉慢性完全闭塞病变患者31例，对其临床资料进行分析。在介入治疗中，导引导丝通过闭塞病变后，球囊或微导管无法通过闭塞病变，或者球囊虽然可以通过闭塞病变但无法充分预扩张，因此采用冠状动脉内旋磨术。手术成功的标准为冠状动脉内旋磨术后成功置入药物洗脱支架，血管残余狭窄<20%。术后对患者进行随访，观察主要不良心脑血管事件，包括心原性死亡、心肌梗死、脑血管意外和靶病变血运重建。 结果： 首选磨头直径为1.25 mm的患者占80.6%（25/31），96.8%（30/31）的患者仅用1个磨头完成冠状动脉内旋磨术操作。术中并发症发生率为9.8%（3/31），其中冠状动脉夹层1例，无复流/慢血流3例，同时出现夹层和慢血流1例。手术成功率为96.8%（30/31）。住院期间，3例患者发生介入治疗相关心肌梗死。手术成功患者在术后随访36（11，96）个月，主要不良心脑血管事件发生率为13.3%（4/30），其中心原性死亡发生率为3.3%（1/30），心肌梗死发生率为6.7%（2/30），脑血管意外发生率为3.3%（1/30），靶病变血运重建发生率为6.7%（2/30）。 结论： 冠状动脉内旋磨术在慢性完全闭塞病变介入治疗中应用安全、有效。.
Keywords: Coronary artery disease; Rotational atherectomy; Treatment outcome.