Steven R. Bailey， M.D.
　　医学和放射学教授，介入心脏病学主任。美国心脏病学学会、美国心脏协会、美国导管和介入学会的会员。现任詹尼布里斯科特聘医学教授和心血管研究中心主任。

　　INTERNATIONAL CIRCULATION: Dr Bailey could you please talk about the potential advantages of using rotational atherectomy when treating calcified stenosis of coronary arteries?
　　国际循环：Bailey医生，能否请您谈一谈采用旋磨术治疗冠状动脉钙化狭窄的潜在优势？
　　Dr Bailey:  What we’ve discovered is we’ve become more aggressive with treating patients is that complete revascularization clearly has an impact on patient outcomes (this sentence is quite awkward， but I don’t know how to improve it). Good data shows that those individuals who are completely re-vascularized do better.  They have fewer events， and more importantly their mortality is less. Whether it’s surgical revascularization for cutainious And as we take on the task of having to approach more of those lesions， we find it’s those complicated lesions， typically either calcific or fibrotic， difficult to pass， that complicate our approach to those individuals and frustrate us and frustrate them. So that rotational atherectomy， because it allows plague remodeling or in fact changes plaque compliance， allows you to do procedures， both more rapidly， as well as to get a better ultimate result. It’s been shown very early on in trials that looked at rotational atherectomy and stenting and compared to stenting alone， although the ultimate result of the stenting， of being able to do the stenting was the same -- the diameter achieved from work done at Washington Hospital Center in Japan and our facility as well -- you achieve a larger lumen， you have better apposition of the stent， both of those we know result in better patient outcomes. So rotational atherectomy allows you to approach lesions that you would not be able to approach otherwise， get better revascularization for a patient and to do it in a way that you get a better result when you do it.
　　Bailey医生：目前对患者的治疗已经开始越来越积极，因为我们发现完全的血运重建对患者的治疗效果具有显著影响。良好的数据显示完全血运重建的患者恢复的更好，他们出现不良事件的几率较少，而且更重要的是他们的死亡率更低。不论其是不是血管成形术引起的。当我们准备着手处理更多病变时，发现这些病变非常复杂，通常要么出现了钙化，要么出现了纤维化，使得手术时难以继续进行，这一情况让这类患者的手术变得很复杂，既让我们感到挫败也让患者们感到灰心。而旋磨术由于能够使重塑斑块或者从实际上改变斑块的依从性，进而使得手术能够顺利进行，其既能加快手术速度又能得到更好的最终疗效。试验早就表明，尽管能够植入支架后支架的最终疗效是一样的，采用旋切术与支架联合与单纯使用支架相比，不论是日本的华盛顿医院中心，还是我们设备中心，其手术所能着手处理的血管直径均显示采用该技术后能够管腔的直径更大，支架的放置位置更好，据我们所知，这两者均能改善患者疗效。所以，旋磨术能让你治疗以前无法处理的病变，让患者获得更好的血运重建，当你采用这种方法，你能获得更好的治疗结果。
　　INTERNATIONAL CIRCULATION: What are the complications of rotational atherectomy?
　　国际循环：旋磨术并发症有哪些呢？
　　Dr Bailey: Well the complications are there. A lot of it is technique. It requires that you understand the tool and that you use the tool appropriately. And in fact if you look at the early studies， because we don’t have a lot of prospective contemporary studies， but from the mid 1990’s comparing balloon angioplasty versus atherectomy， you actually had fewer stents placed because you had fewer dissections then you did with balloon angioplasty. If you are talking about preparing a lesion then you have a more benign lesion to prepare. Now there are down sides. You have a risk of perforation. It turns out that risk was not different from balloon angioplasty on these complex lesions because you’re using higher pressures and you are dilating more. There’s a risk of “no reflow” and that’s probably the one that people talk about the most. But it turns out that we have good pharmacologic therapy for that. So if you prepare the patient vessel using nitroprusside， using adenosine， so that you’ve opened up that vascular bed then you can affect that as well. And finally there is， in dominant right coronaries， a slightly higher likelihood that you will get bradycardia but again that could be modified with a pre-aminofolin drip in those patients， 5mgs per Kg of aminofolin administered before you do the procedure， essentially eliminates the need to have to do pacing.
　　Bailey医生：确实有一些并发症，很大程度上是技术性的问题。避免出现技术性问题要求你了解这一工具，而且能适当的进行应用。事实上，当你回顾早期研究的时候，由于前瞻性的当代研究并不多，而多是一些20世纪90年代的比较球囊成形术和血栓切除术的研究，因为解剖的较少，因此支架植入术比球囊血管成形术要少。当你说你要准备治疗一个病变时，你为之准备的病变应该是个较良性的病变。现在也有不足之处，手术有穿孔的危险。事实证明，现在对于这些复杂病变的治疗，其风险与采用球囊成形术相比没有什么区别，因为现在采用的压力更高，血管扩张的更大了。“不回流”的风险可能是人们谈论最多的风险之一。但是事实证明，我们有很好的药物疗法来应对这种情况。所以，当你采用硝普纳、腺苷来为患者血管进行术前准备以便开辟血管床的时候，你还可以对其施加影响。最后，在治疗右冠状动脉的时候，出现心动过缓的可能性稍高，但是在这类患者中预先滴注氨茶碱，心动过缓也是可以预防的，在手术前进行5毫克/千克的氨茶碱给药，能够基本消除心脏起搏的需要。
　　INTERNATIONAL CIRCULATION: Would you please discuss the result of clinical studies which address the efficacy and safety of this procedure in patient with ischemic heart disease?
　　国际循环：有些临床试验是关于缺血性心脏病患者实施该类手术的有效性和安全性的，能否请您谈一谈这类临床试验的研究结果？
　　Dr Bailey: Well we don’t have really very much in the way of efficacy， in terms of outcomes in patients. The studies that were done have primarily been small， like DART and SPORT and STRATUS that either examined the procedural outcomes compared to other standards or the technical approach. So in SPORT and DART what we found was you could do this safely， but they were powered to look at clinical or angiographic restenosis. And we didn’t see differences once we performed the procedure in those outcomes. In terms of long-term efficacy， we really haven’t had trial that have examined that question.
　　Bailey医生：对于患者治疗效果方面的数据真的不是很多。我们所做的试验基本上都比较小，比如DART 试验，SPORT 试验以及 STRATUS试验，要么将手术结果与与其他标准疗法进行了对比，要么与技术方法进行了对比。所以在SPORT 试验和STRATUS试验中，我们了解到该手术具有安全性，但是他们更关注临床或血管造影中的再狭窄。当我们进行了手术后，在这些结果中并没有发现区别。至于该技术的长期疗效，目前我们真还没有这方面的试验对此进行研究。

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