Comparison of complications with a 1.25-mm versus a 1.5-mm burr for severely calcified lesions that could not be crossed by an intravascular ultrasound catheter
Comparison of complications with a 1.25-mm versus a 1.5-mm burr for severely calcified lesions that could not be crossed by an intravascular ultrasound catheter
复制标题
DOI：
10.1007/s12928-019-00606-9
复制
发表时间：
2020-07-01
影响因子：
3.2
通讯作者：
Fujita, Hideo
中科院分区：
文献类型：
--
作者：
Sakakura, Kenichi;Taniguchi, Yousuke;Fujita, Hideo
由于血管内成像如血管内超声（IVUS）可以为旋转动脉粥样硬化切除术（RA）提供有用的信息，因此在RA之前应尝试血管内成像。然而，一些钙化病变在RA前不允许显像导管穿过。虽然小毛刺（1.25 mm或1.5 mm）应该选择这种紧密的病变，但尚不清楚1.25 mm毛刺还是1.5 mm毛刺作为初始毛刺更安全。本研究的目的是比较1.25 mm和1.5 mm毛刺作为ivus无法跨越病变的初始毛刺的并发症发生率。这是一项回顾性的单中心研究。共纳入109个ivus不可交叉病变，分为1.25 mm组（n =52）和1.5 mm组（n =57）。两组RA术后慢流发生率无显著差异（1.25 mm组：25%，1.5 mm组：31.6%,P =0.45）。两组术中心肌梗死伴慢血流发生率无差异，均较低（1.25 mm组：1.9%，1.5 mm组：3.5%,P =0.61）。在控制了血液透析和参考直径的慢性肾衰竭后，使用1.5 mm毛刺作为初始毛刺与血流缓慢没有显著相关（vs. 1.25 mm: OR 2.34, 95% CI 0.89-6.19,P =0.09）。总之，对于ivus无法跨越的病变，1.25 mm毛刺和1.5 mm毛刺在RA后的并发症发生率相当。目前的研究为ivus无法跨越的病变选择合适的毛刺提供了见解。
Since intravascular imaging such as intravascular ultrasound (IVUS) can provide useful information for rotational atherectomy (RA), intravascular imaging should be attempted before RA. However, some calcified lesions do not allow imaging catheters to cross before RA. Although small burrs (1.25 mm or 1.5 mm) should be selected for such tight lesions, it is unknown whether a 1.25-mm burr or 1.5-mm burr is safer as the initial burr. The aim of this study was to compare the incidence of complications with a 1.25-mm versus a 1.5-mm burr as the initial burr for IVUS-uncrossable lesions. This was a retrospective, single-center study. A total of 109 IVUS-uncrossable lesions were included, and were divided into a 1.25-mm group (n =52) and a 1.5-mm group (n =57). The incidence of slow flow just after RA was not different between the 2 groups (1.25-mm group: 25%, 1.5-mm group: 31.6%,P =0.45). The incidence of peri-procedural MI with slow flow was not different and equally low in the 2 groups (1.25-mm group: 1.9%, 1.5-mm group: 3.5%,P =0.61). The use of the 1.5-mm burr as the initial burr was not significantly associated with slow flow after controlling for chronic renal failure on hemodialysis and reference diameter (vs. 1.25-mm: OR 2.34, 95% CI 0.89-6.19,P =0.09). In conclusion, the incidence of complications following RA was comparable between the 1.25-mm and the 1.5-mm burrs as the initial burr for IVUS-uncrossable lesions. The present study provides insights into the selection of an appropriate burr for IVUS-uncrossable lesions.