Efficacy and safety of rotational atherectomy combined with drug eluting coronary in the treatment of severe coronary artery calcified lesions

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. Key words: Coronary artery calcification; Coronary rotational atherectomy; Drug eluting stent; Complication; Major adverse cardiovascular events