血管内超声（IVUS）被广泛应用于检测冠状动脉内成像形态，在介入治疗时使血管壁清楚的呈现在眼前。然而，IVUS具有评估严重钙化成分的局限性，因为声影区减弱了深层血管壁的结构成像。冠状动脉内旋磨术（RA）用于治疗严重钙化病变[1-4]。一些研究显示，RA的无反流/血流缓慢现象较其他冠状动脉血管重建设备更常见[5-9]。融化斑块的特点，在无反流/血流缓慢现象中起到很重要的作用，不能够通过IVUS显像，可能会影响RA的结果。

    近期的研究通过组织学检查发现IVUS声影区后的斑块特性[10]。我们通过IVUS和组织学检查检测了40具尸体(男性24，  女性16, 平均年龄 74 ± 7 岁)的108个冠状动脉段。我们发现，严重钙化病变核心坏死和纤维脂肪性组织成分的发生率与之前报道的无严重钙化的冠状动脉段同样高[11]。一些临床研究显示RA的无反流/血流缓慢现象较其他冠状动脉血管重建设备更常见，发生率6-15%。这些现象会导致严重缺血的并发症，如传导紊乱、心梗和心源性休克或死亡[12]。

    因此，弄清楚RA操作中斑块特性的影响很重要。通常，急性冠脉综合征患者的脂肪组织突入血管内腔可能导致腔内血栓形成[13]。此外，那些脂质复合物的存在可以作为急性冠脉综合征患者进行经皮冠脉血管成形术时出现无血流现象的预测因子[14]。所以，在RA操作过程中，这些钙化后“隐密”的核心坏死和纤维脂肪性组织成分可能突入管腔，导致血栓形成，类似急性冠脉综合征。因为这是一个尸体解剖研究，活体内RA操作中斑块成分和远端血流障碍的直接关系还不是很清楚。然而，核心坏死和纤维脂肪性组织与之前报道的严重冠脉疾病病变同样高发。RA操作过程中，钙化后面“隐密”的核心坏死和纤维脂肪性组织成分可能导致血栓形成和远端血流障碍。

    参考文献：

    1. Warth DC, Leon MB, O'Neill W, Zacca N, Polissar NL, Buchbinder M. Rotational atherectomy multicenter registry: acute results, complications and 6-month angiographic follow-up in 709 patients. J Am Coll Cardiol 1994;24:641-48.
    2. Stertzer SH, Rosenblum J, Shaw RE, et al. Coronary rotational ablation: initial experience in 302 procedures. J Am Coll Cardiol 1993;21:287-95.
    3. Meany TB, Friedman HZ, O'Neill WW. Coronary rotational atherectomy: clinical application. J Invasive Cardiol 1991;3:19-24.
    4. Teirstein PS, Warth DC, Haq N, et al. High speed rotational coronary atherectomy for patients with diffuse coronary artery disease. J Am Coll Cardiol 1991;18:1694-1701.
    5. Safian RD, Freed M, Lichtenberg A, et al. Are residual stenoses after excimer laser angioplasty and coronary atherectomy due to inefficient or small devices? Comparison with balloon angioplasty. J Am Coll Cardiol 1993;22:1628-34.
    6. Ellis SG, Popma JJ, Buchbinder M, et al. Relation of clinical presentation, stenosis morphology, and operator technique to the procedural results of rotational atherectomy and rotational atherectomy-facilitated angioplasty. Circulation 1994;89:882-92.
    7. Hanna GP, Yhip P, Fujise K, et al. Intracoronary adenosine administered during rotational atherectomy of complex lesions in native coronary arteries reduces the incidence of no-reflow phenomenon. Catheter Cardiovasc Interv 1999;48:275-58.
    8. Bowers TR, Stewart RE, O'Neill WW, Reddy VM, Safian RD. Effect of Rotablator atherectomy and adjunctive balloon angioplasty on coronary blood flow. Circulation 1997;95:1157-64.
    9. Tanaka T, Shimizu Y, Ishihara A, Yano K, Sada T, Kira Y. Effect of rotational atherectomy on the coronary microcirculation in patients with angina pectoris. J Cardiol 2005;46:43-51.
    10. Kume T, Okura H, Kawamoto T, et al. Assessment of histological characteristics in coronary arterial plaque with severe calcification. Circ J 2007;71:643-47.
    11. Fujii K, Carlier SG, Mintz GS, et al. Association of plaque characterization by intravascular ultrasound virtual histology and arterial remodeling. Am J Cardiol 2005;96:1476-83.
    12. Abbo KM, Dooris M, Glazier S, et al. Features and outcome of no-reflow after percutaneous coronary intervention. Am J Cardiol 1995;75:778-82.
    13. Virmani R, Kolodgie FD, Burke AP, Farb A, Schwartz SM. Lessons from sudden coronary death: a comprehensive morphological classification scheme for atherosclerotic lesions. Arterioscler Thromb Vasc Biol 2000;20:1262-75.
    14. Tanaka A, Kawarabayashi T, Nishibori Y, et al. No-reflow phenomenon and lesion morphology in patients with acute myocardial infarction. Circulation 2002;105:2148-52.