目的总结冠状动脉旋磨术在高危冠状动脉钙化病变中应用的经验,分析该技术治疗高危钙化病变患者的安全性及近、远期预后。方法回顾分析2010年1月至2014年12月接受冠状动脉旋磨术结合支架植入术治疗患者130例,其中符合高危复杂钙化病变患者23例。分析术前术后冠状动脉DSA造影资料及临床信息,评估介入术并发症和主要心脑血管不良事件发生率。结果 23例患者26处钙化病变均接受冠状动脉旋磨术,其中15处(57.7%)、7处(26.9%)、4处(15.4%)病变分别以初始直径1.25 mm、1.5 mm、1.75 mm磨头开始旋磨。23处病变(88.5%)成功旋磨并顺利植入支架,即刻效果满意,无并发症;3处(11.5%)病变未植入支架,原因分别为血管太细、血管穿孔和支架内再狭窄,仅作旋磨术。术中发生冠状动脉夹层1处(3.8%),支架植入后边支闭塞2处(7.7%),血管穿孔1处(3.8%),无复流2处(7.7%)及支架内残余狭窄1例(3.8%)。住院期间无死亡事件发生,发生支架植入术后心肌梗死3例(13.0%),对比剂肾病2例(8.7%)。术后1年随访发现5例(21.7%)心绞痛症状再发,其中2例经造影证实与支架内再狭窄有关。21例获随访4~60个月,平均(25.5±10.7)个月,结果 4例病死,2例再行血管重建术。结论冠状动脉旋磨术治疗高危钙化病变安全、有效,术中根据病变特点遵循“磨头更小、推进更慢、分段旋磨”的原则,手术成功率高,并发症发生率低,术后主要心脑血管不良事件发生率低。 Objective To summarize the experience of corneal atherectomy in the treatment of high-risk coronary artery calcification and to analyze the safety, short-term and long-term prognosis of the patients with high-risk calcification. Methods A retrospective analysis of 130 patients undergoing rotational atherectomy combined with stent-graft from January 2010 to December 2014 was performed, of which 23 matched with high-risk and complex calcifications. Preoperative and postoperative coronary DSA angiography data and clinical information were analyzed to assess the incidence of interventional complications and major cardiovascular and cerebrovascular adverse events. Results Twenty-six calcified lesions of 23 patients were treated by rotational atherectomy. Among them, 15 (57.7%), 7 (26.9%) and 4 (15.4% Grinding head began rotary grinding. Thirty-two lesions (88.5%) were successfully spun and successfully implanted into the scaffolds. The immediate results were satisfactory and no complications were found. Three (11.5%) lesions were not implanted into scaffolds due to too thin blood vessels, perforation of blood vessels and in-stent restenosis , Only for rotation grinding. There were 1 coronary artery occlusion (3.8%), 2 occlusion (7.7%), 1 perforation (3.8%), 2 no-reflow (7.7%) and 1 Example (3.8%). There were no deaths during hospitalization, 3 (13.0%) with myocardial infarction and 2 with contrast agent nephropathy (8.7%) after stenting. Five patients (21.7%) had recurrence of angina pectoris at follow-up one year after surgery. Two of them were confirmed by contrast-enhanced angiography and were related to in-stent restenosis. Twenty-one patients were followed up for 4 to 60 months, with an average of (25.5 ± 10.7) months. Four patients died and two patients underwent revascularization. Conclusion Coronary atherectomy is safe and effective in the treatment of high-risk calcified lesion. According to the characteristics of lesion, the principle of “smaller head, slower propulsion and segmental rotational atherectomy” was followed up during operation. The high success rate and low complication rate , Postoperative major cardiovascular and cerebrovascular adverse events were low.