Background: Coronary calcification is a major determinant of stent underexpansion and subsequent adverse events. This study aimed to evaluate the acute- and long-term outcomes of rotational atherectomy (RA) followed by cutting balloon (CB) versus plain balloon before drug-eluting stent implantation for calcified coronary lesions.
Methods: From June April 2013 to March 2016, a total of 127 patients with moderately or severely calcified coronary lesions were treated with RA. Patients were divided into two groups according to the balloon type after RA: RA+CB group (n = 75) and RA+plain balloon group (n = 52). Minimal lumen diameter and acute lumen gain were analyzed by quantitative coronary angiography. In-hospital and long-term (>1 year) outcomes were recorded. Multivariate Cox regression analysis was performed to determine the independent predictors of in-stent restenosis.
Results: The mean age of the patients was 65.5 years, and 76.4% were men. Total lesion length and minimal lumen diameter at baseline were similar in the two groups. After RA and balloon dilation, the lumen diameter was significantly larger in the RA+CB group than in the RA+plain balloon group (1.57 ± 0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P < 0.001). The final lumen diameter was also larger in the RA+CB group compared to that in the RA group (2.81 ± 0.41 mm vs. 2.60 ± 0.25 mm, t = 2.111, P = 0.039). Moreover, patients receiving RA and CB tended to have larger final lumen gain (2.15 ± 0.48 mm vs. 1.95 ± 0.47 mm, t = 1.542, P = 0.132). Multivariate Cox regression analysis indicated that the strategy of RA+CB was a significant protective factor against long-term (>1 year) in-stent restenosis (hazard ratio: 0.136, 95% confidence interval: 0.020-0.936, P = 0.043).
Conclusions: In patients with moderately or severely calcified lesions, a strategy of RA followed by CB before stent implantation can increase lumen diameter and acute lumen gain. This strategy is safe with lower risk of long-term in-stent restenosis.
冠状动脉钙化病变药物洗脱支架植入前采用旋磨联合切割球囊对比普通球囊的急性期和远期结局摘要背景：冠状动脉钙化是支架膨胀不良和不良事件的主要决定因素。本研究旨在评估冠状动脉钙化病变药物洗脱支架植入前采用旋磨联合切割球囊对比普通球囊的急性期和远期结局。 方法：从2013年4月到2016年3月，共127例中重度钙化病变患者接受旋磨术。根据旋磨后球囊类型分为旋磨+切割球囊组（n=75）和旋磨+普通球囊组（n=52）。采用定量冠状动脉造影分析最小管腔直径和急性管腔获得，并记录院内和长期（>1年）结局。采用多因素Cox回归分析支架内再狭窄的独立预测因素。 结果：患者平均年龄65.5岁，76.4%是男性。两组基线总病变长度和最小管腔直径相当。旋磨和球囊扩张后，旋磨+切割球囊组管腔直径明显大于旋磨+普通球囊组（1.57 ± 0.46 mm vs. 1.10 ± 0.40 mm, t = 4.123, P < 0.001）。旋磨+切割球囊组最终管腔直径明显大于旋磨+普通球囊组（2.81 ± 0.41 mm vs. 2.60 ± 0.25 mm, t = 2.111, P = 0.039）。此外，旋磨+切割球囊组患者最终管腔获得有增大趋势（2.15 ± 0.48 mm vs. 1.95 ± 0.47 mm, t = 1.542, P = 0.132）。多因素Cox回归分析提示，旋磨+切割球囊策略是远期（>1年）支架内再狭窄的保护因素（风险比: 0.136, 95%置信区间: 0.020-0.936, P = 0.043）。 结论：对于中重度钙化病变患者，支架植入前采用旋磨联合切割球囊策略增加管腔直径和急性管腔获得。该策略是安全的， 且远期支架内再狭窄风险较低。.
Keywords: Calcification; Cutting Balloon; Rotational Atherectomy.