CBS 2019
CBSMD教育中心
English

科学研究

科研文章

荐读文献

Intravascular Ultrasound and Angioscopy Assessment of Coronary Plaque Components in Chronic Totally Occluded Lesions Impact of Positive and Negative Lesion Site Remodeling on Clinical Outcomes : Insights From PROSPECT Transcatheter versus Surgical Aortic Valve Replacement in Patients with Prior Cardiac Surgery in the Randomized PARTNER 2A Trial Incidence and Outcomes of Surgical Bailout During TAVR : Insights From the STS/ACC TVT Registry Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review Longitudinal Change in Galectin-3 and Incident Cardiovascular Outcomes Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis The Evolution of β-Blockers in Coronary Artery Disease and Heart Failure (Part 1/5) Novel predictors of late lumen enlargement in distal reference segments after successful recanalization of coronary chronic total occlusion A Combined Optical Coherence Tomography and Intravascular Ultrasound Study on Plaque Rupture, Plaque Erosion, and Calcified Nodule in Patients With ST-Segment Elevation Myocardial Infarction: Incidence, Morphologic Characteristics, and Outcomes After Percutaneous Coronary Intervention

Clinical Trial1998 Aug;19(8):1224-31.

JOURNAL:Eur Heart J. Article Link

Treatment of calcified coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study

Hoffmann R, Mintz GS, Popma JJ et al. Keywords: calcified coronary lesions; intracoronary stents, IVUS, rotational atherectomy

ABSTRACT


AIMSTo evaluate the result of coronary stenting in calcified lesions and to find morphological and procedural factors influencing the final result.


METHODS AND RESULTS - Three hundred and twenty three native coronary artery lesions in 303 patients (197 men, mean age 63.9 +/- 11.5 years) treated with Palmaz-Schatz stents were differentiated into four groups depending on their degree of circumferential calcification as defined by intravascular ultrasound [0-90 degrees (n=120), 91-180 degrees (n=58, 181-270$ (n=71) and 271-360 degrees n=74)]. In 117 lesions rotational atherectomy was used prior to stent placement. Intravascular ultrasound and quantitative angiography were performed prior to treatment and after stent placement to measure minimal and maximal lumen diameter and lumen cross-sectional area at the lesion site and the reference segments. Acute lumen gain and eccentricity index were calculated. Although higher balloon pressures were used than in the minimally calcified lesions. the final angiographic minimal lumen diameter decreased with increasing arc of calcification (3.01 +/- 0.47, 3.04 +/- 0.43, 2.85 +/- 0.53, 2.83 +/- 0.40 mm, respectively, P=0.0320) resulting in a decrease in acute diameter gain with increasing arc of calcification (2.06 +/- 0.51, 1.91 +/- 0.46, 1.81 +/- 0.56, 1.78 +/- 0.51 mm, respectively, P=0.0067). Adjunctive rotational atherectomy prior to stent placement resulted in a greater acute diameter and a greater lumen cross-sectional area gain, coupled with less final residual stenosis than pre-treatment with balloon angioplasty.

CONCLUSION - Implantation of stents in calcified lesions results in less optimal stent expansion, especially in lesions with thick, eccentric calcific plaque layers. Use of adjunctive rotational atherectomy before stent placement may improve the procedural result.