冠状动脉内旋磨术并发症分析、预防及处理技巧

摘要

目的 分析冠状动脉内旋磨术并发症的发生情况、预防及处理方法.方法 分析大庆油田总医院自2000年1月至2016年10月连续248例成功行冠状动脉内旋磨术患者并发症发生情况、预防及处理结果.结果 共有27例(10.9％)患者发生旋磨术并发症,其中冠状动脉痉挛2例(0.8％)、慢血流/无复流8例(3.2％)、夹层5例(2.0％)、旋磨头嵌顿6例(2.4％)、导丝断裂3例(1.2％)及冠状动脉穿孔3例(1.2％),所有术中并发症均通过介入治疗成功处理.住院期间共有14例(5.6％)患者发生主要不良心脑血管事件(major adverse cardiac and cerebrovascular events,MACCE),均为介入治疗相关心肌梗死.无心源性死亡、无卒中、无靶病变血运重建发生.结论 冠状动脉内旋磨术治疗钙化病变并发症发生率较低,具有同常规介入治疗相似的安全性.%Objective To analyze the complications of coronary rotational atherectomy and to evaluate the safety of the procedure. Methods We evaluated the procedural and angiographic outcomes of 248 consecutive procedures to rotational atherectomy between January 2000 and October 2016. Results 27 cases(10.9％)were found to have rotational atherectomy related complications. Among these 27 cases,coronary spasm occurred in 2 cases(0.8％),no reflow in 8 cases(3.2％), coronary dissection in 5 cases(2.0％),burr entrapment in 6 cases(2.4％),wire breakage in 3 cases(1.2％), and coronary perforation in 3 cases(1.2％). There were no death,acute myocardial infarction and emergent coronary bypass graft.14 case(5.6％)had PCI-related myocardial infarction during hospital stay.In-hospital major adverse cardiaccerebral event(MACCE)rate was 5.6％. Conclusions Coronary rotational atherectomy can be performed with high success rates and procedure-related complications are rare.