ABSTRACT
ObjectiveThe development of new endovascular imaging techniques has optimized surgical treatment strategies. In this paper, we investigated the effect of rotational atherectomy (RA) guided by intravascular ultrasound (IVUS) on long-term postoperative follow-ups.MethodsClinical data of 211 patients who underwent RA in the Department of Cardiology, Nanjing Drum Tower Hospital from November 2011 to December 2018 were retrospectively analyzed, and they were divided into IVUS Group (116 patients) and Non-IVUS Group (95 patients) according to whether they underwent the guidance of intravascular ultrasound or not. Basic information of all patients, coronary artery lesions and details of operation and other clinical data were collected. The long-term prognosis of the patients was collected and compared by telephone or outpatient follow-ups.ResultsThe head diameter, average stent diameter and total hospitalization expenses of the IVUS Group were significantly higher than those of the Non-IVUS Group, and the differences were statistically significant [(1.53±0.19) mm vs (1.46±0.14) mm, P=0.001; (3.09±0.48) mm vs (2.87±0.30) mm, P0.05). Multivariate COX regression analysis showed that the cardiogenic mortality was significantly reduced in the IVUS Group (HR=0.10, 95%CI: 0.02~0.63, P=0.014), but there was no statistically significant difference between the two groups in the incidence of all-cause death and long-term MACE (P>0.05).ConclusionCompared with the Non-IVUS Group, IVUS-guided RA can significantly reduce the incidence of long-term cardiogenic death and total hospitalization expenses.
ABSTRACT
ObjectiveThe development of new endovascular imaging techniques has optimized surgical treatment strategies. In this paper, we investigated the effect of rotational atherectomy (RA) guided by intravascular ultrasound (IVUS) on long-term postoperative follow-ups.MethodsClinical data of 211 patients who underwent RA in the Department of Cardiology, Nanjing Drum Tower Hospital from November 2011 to December 2018 were retrospectively analyzed, and they were divided into IVUS Group (116 patients) and Non-IVUS Group (95 patients) according to whether they underwent the guidance of intravascular ultrasound or not. Basic information of all patients, coronary artery lesions and details of operation and other clinical data were collected. The long-term prognosis of the patients was collected and compared by telephone or outpatient follow-ups.ResultsThe head diameter, average stent diameter and total hospitalization expenses of the IVUS Group were significantly higher than those of the Non-IVUS Group, and the differences were statistically significant [(1.53±0.19) mm vs (1.46±0.14) mm, P=0.001; (3.09±0.48) mm vs (2.87±0.30) mm, P0.05). Multivariate COX regression analysis showed that the cardiogenic mortality was significantly reduced in the IVUS Group (HR=0.10, 95%CI: 0.02~0.63, P=0.014), but there was no statistically significant difference between the two groups in the incidence of all-cause death and long-term MACE (P>0.05).ConclusionCompared with the Non-IVUS Group, IVUS-guided RA can significantly reduce the incidence of long-term cardiogenic death and total hospitalization expenses.
ABSTRACT
Objective To investigate the efficacy and safety of rotational atherectomy(RA)combined with drug eluting stent(DES)implantation in the treatment of severe coronary artery calcification,and analyze key operation points.Methods The clinical data of sixty-two patients(68 lesions)treated with RA combined with DES from January 2014 to December 2015 were retrospectively analyzed,including the characteristics of operation,postoperative curative effect,complications,incidence of major adverse cardiovascular events(MACE) during hospitalization and follow-up period.Results A total of 75 rotary blur were used in the 62 cases,with an average of(1.18±0.27)per case,the blur diameter/target vessel diameter was(0.54±0.07),the success rate of RA was 98.4%(61/62);A toal of 103 DES were implanted in 61 patients,with an average of(1.67±0.55)per case,average length was(44.5 ± 11.8)mm,immediate DES success rate was 100%.After RA,target vessel diameter was(2.33± 0.52)mm,target vessel narrow degree was(29.6 ± 4.8)%,thrombolysis in myocardial infarction grade Ⅲ blood flow ratio was 66.2%,which have been significantly improved compared with preoperation((0.75±0.21)mm,(82.5±7.2)%,10.3%)(P<0.05),the target vascular lumen diameter and stenosis of target vessel continued to improve after DES((3.26 ± 0.43)mm,(8.7 ± 2.1)%,98.5%)(P<0.05);At 3 days after operation,the left ventricular ejection fraction was significantly higher than that before the operation((60.5±5.5)% vs.(56.8±4.7)%)(P<0.05).The incidence of complications associated with interventional procedures was 9.7%,in which 1 case with burr incarceration switched to coronary artery bypass grafting.The incidence of major adverse cardiovascular events incidence during hospitalization was 4.8%,the follow-up period was 9.0-22.0 months.The incidence of major adverse cardiovascular events incidence during follow-up was 8.2%.Conclusion DES implantation following RA in the treatment of severe coronary artery calcification can further improve blood flow and artery stenosis,medium-term efficacy is safe and reliable;standardized RA operation is the key to ensure the success of interventional therapy.
ABSTRACT
Objective To investigate the safety and short-term outcome of rotational atherectomy followed by drug-eluting stenting in heavily calcified coronary long lesions. Methods From Jan 1, 2011 to May 31, 2016, 109 cases with 114 heavily calcified coronary lesions which were treated with rotational atherectomy followed by drug-eluting stenting in Peking University People's Hospital were included. They were divided into diffuse lesion group ( lesion ≥25 mm, 68 cases, 72 lesions ) and focal lesion group (lesion ﹤25 mm,41 cases, 42 lesions). All patients were followed up in hospital. Procedure parameters, procedural complications ( dissection, perforation, slow flow/no flow and procedural related myocardial infarction),procedural success and major adverse cardiovascular events (cardiac death, non-fatal myocardial infarction and stent thrombosis) were analyzed. Results The procedural success rate was 98. 5%(67/68) in diffuse lesion group and 100% ( 41/41 ) in focal lesion group ( P=0. 453 ) . Complication rates did not differ between the two groups (41. 2% and 34. 1%, P=0. 673). Major adverse cardiovascular events rates were 41. 2% and 31. 7%, P =0. 484. Conclusions Treating coronary lesions ≥25 mm in length with rotational atherectomy followed by drug-eluting stenting does not impact the short-term outcome when treating carefully and correctly . Procedural success rate and in-hospital outcome is satisfactory.
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Objective To investigate the safety and efficacy of rotational atherectomy in coronary artery calcification lesions used domestic drug eluting stent.Methods Clinical data of 14 patients with 20 coronary artery calcification lesions were analyzed. The success rates and follow-up results of rotational atherectomy in coronary artery calcification lesions used domestic drug eluting stent were analyzed.Results Procedural success was achieved in all patients.No main adverse cardiovascular events (including cardiac death, Q wave myocardial infarction and emergency coronary surgery) occurred during operation. 9 patients (64.3%) were checked by coronary angiography after 9 months, and no one was found with in-stent restenosis. Conclusion Rotational atherectomy in coronary artery calcification lesions used domestic drug eluting stent is effective and safe in the treatment of coronary artery calcification lesions, it can increase the success rate of percutaneous coronary intervention .