左主干旋转消融术:北印度一家三级医疗中心的病例系列

Himanshu Gupta, S. Verma, Y. Sharma, Navjyot Kaur, K. A. Ary
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摘要

背景:钙化左主干(LM)疾病是冠状动脉疾病的一个重要分支,具有高风险和手术复杂性。经皮冠状动脉介入治疗(PCI)的进步使其成为冠状动脉旁路移植术的可行替代方案。方法:这是一项回顾性研究,研究对象是2018年8月至2023年5月期间在印度北部的一家三级医疗中心接受了旋转孔切除术(RA)辅助的LM疾病PCI的年龄≥18岁的患者。PCI还根据情况使用了血管内超声和斑块修饰辅助疗法,如切割球囊和血管内碎石术。对手术细节和临床结果进行了分析。研究结果该研究连续纳入了 55 例患者。男性患者共 52 人(94.5%),平均年龄(64.7±9.0)岁。平均随访时间为(16.3 ± 11.2)个月。平均射血分数为(52.7 ± 8.2%)。血管造影的平均SYNTAX评分为(34.9±7.7)分,22名患者(40%)存在真正的分叉病变(Medina分级1,1,1或1,1,0)。25名患者(45.5%)接受了切割球囊治疗,9名患者(16.4%)接受了血管内碎石治疗。46名患者(83.6%)使用了血管内超声引导。6例患者(10.9%)接受了辅助PCI治疗。100%的患者都获得了血管造影成功。一名患者(1.8%)因上消化道出血在医院死亡。随访期间,一名患者死亡(1.8%),三名患者(5.5%)需要进行靶血管再通术。结论通过合理使用血管内超声和斑块修饰辅助疗法,可以安全地对钙化性 LM 病进行旋转动脉粥样硬化切除术辅助 PCI 治疗,并获得令人满意的中短期疗效。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Left Main Rotablation: Case Series From a Tertiary Care Centre in North India
Background: Calcified left main (LM) disease is an important subset of coronary artery disease, associated with a high risk and procedural complexity. Advances in percutaneous coronary intervention (PCI) are making it a viable alternative to coronary artery bypass grafting. Methods: This was a retrospective study of patients aged ≥18 years who underwent rotational atherectomy (RA)-assisted PCI of LM disease at a tertiary-care centre in North India from August 2018 to May 2023. PCIs also involved use of intravascular ultrasound and adjuvant plaque-modifying therapies, such as cutting balloons, and intravascular lithotripsy, as indicated. Procedural details and clinical outcomes were analysed. Results: The study included 55 consecutive patients. A total of 52 patients (94.5%) were men, and the mean age was 64.7 ± 9.0 years. The mean follow-up was 16.3 ± 11.2 months. The mean ejection fraction was 52.7 ± 8.2%. On angiography, the mean SYNTAX score was 34.9 ± 7.7, and true bifurcation lesions (Medina class 1,1,1 or 1,1,0) were present in 22 patients (40%). Adjuvant plaque modification therapy included a cutting balloon in 25 patients (45.5%), and intravascular lithotripsy in nine (16.4%). Intravascular ultrasound guidance was used in 46 patients (83.6%). Supported PCI was performed in six cases (10.9%). Angiographic success was achieved in 100% of the patients. One patient (1.8%) died in hospital due to an upper gastrointestinal bleed. On follow-up, one patient died (1.8%), and target vessel revascularisation was needed for three patients (5.5%). Conclusion: Rotational atherectomy-assisted PCI for calcific LM disease can be performed safely, with judicious use of intravascular ultrasound and adjunct plaque modification therapies, providing satisfying short- to medium-term outcomes.
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