High-Speed Rotational Atherectomy Versus Modified Balloons Prior to Drug-Eluting Stent Implantation in Severely Calcified Coronary Lesions: The Randomized PREPARE-CALC Trial
High-Speed Rotational Atherectomy Versus Modified Balloons Prior to Drug-Eluting Stent Implantation in Severely Calcified Coronary Lesions: The Randomized PREPARE-CALC Trial
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DOI：
10.1161/circinterventions.118.007415
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发表时间：
2018-10-01
影响因子：
5.6
通讯作者：
Richardt, Gert
中科院分区：
文献类型：
--
作者：
Abdel-Wahab, Mohamed;Toelg, Ralph;Richardt, Gert
背景：球囊扩张或减积似乎是钙化冠状动脉病变成功植入支架的关键。与标准球囊预扩张相比，使用高速旋切术（RA）进行减积与较高的初始手术成功率相关，尽管中期随访时支架内晚期管腔丢失较高。尚不清楚改良（刻痕或切割）球囊（MB）是否可以获得与RA相似的手术成功。此外，新一代药物洗脱支架是否可以抵消RA引发的过度新生内膜增殖仍有待确定。方法和结果：我们随机分配患者记录心肌缺血和严重钙化的本地冠状动脉病变经皮冠状动脉介入治疗的战略病变准备使用MB或RA，然后药物洗脱支架植入。使用第三代西罗莫司洗脱支架和生物可吸收聚合物进行支架植入术。该试验有2个主要终点：策略成功（定义为成功的支架输送和扩张，
Background: Balloon dilatation or debulking seems to be essential to allow successful stent implantation in calcified coronary lesions. Compared with standard balloon predilatation, debulking using high-speed rotational atherectomy (RA) is associated with higher initial procedural success albeit with higher in-stent late lumen loss at intermediate-term follow-up. Whether modified (scoring or cutting) balloons (MB) could achieve similar procedural success compared with RA is not known. In addition, whether new-generation drug-eluting stents could counterbalance the excessive neointimal proliferation triggered by RA remains to be determined.Methods and Results: We randomly assigned patients with documented myocardial ischemia and severely calcified native coronary lesions undergoing percutaneous coronary intervention to a strategy of lesion preparation using MB or RA followed by drug-eluting stent implantation. Stenting was performed using a third-generation sirolimus-eluting stent with a bioabsorbable polymer. The trial had 2 primary end points: strategy success (defined as successful stent delivery and expansion with attainment of