动脉血管钙化斑块旋磨研究综述

翟少波; 刘瑶; 沈斌; 李嘉豪; 郭占玲

doi:10.13394/j.cnki.jgszz.2023.0162

动脉血管钙化斑块旋磨研究综述

doi: 10.13394/j.cnki.jgszz.2023.0162

翟少波^1,,
刘瑶^{1, 2, ,},
沈斌³,
李嘉豪¹,
郭占玲³

1.
中北大学机械工程学院, 太原 030051
2.
广东省微创手术器械设计与精密制造重点实验室, 广州 510000
3.
浙江清华长三角研究院海纳精密加工中心, 浙江嘉兴 314000

基金项目: 广东工业大学广东省微创手术器械设计与精密制造重点实验室开发基金资助项目（MISIMT-2022-2）；浙江省自然科学基金资助项目（LY23E050002）；山西省基础研究计划面上项目（资助号：202303021211146）；平湖市科技计划项目（GY202418）。

详细信息

通讯作者:
刘瑶，男，1990年生，博士、副教授。主要研究方向：生物组织加工和精密磨削。 E-mail：liuyao@nuc.edu.cn

中图分类号: TG58; TG74; R608
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- 被引次数: 0
出版历程
- 收稿日期: 2023-08-08
- 修回日期: 2023-11-20
- 录用日期: 2023-11-28
- 网络出版日期: 2024-09-25
- 刊出日期: 2024-08-20

Review of research on arterial vascular calcified plaque grinding

ZHAI Shaobo^1
,,
LIU Yao^{1, 2
, ,},
SHEN Bin³,
LI Jiahao¹,
GUO Zhanling³

1.
School of Mechanical Engineering, North University of China, Taiyuan 030051, China
2.
Guangdong Key Laboratory of Minimally Invasive Surgical Instrument Design and Precision Manufacturing, Guangzhou 510000, China
3.
Zhejiang Tsinghua Yangtze River Delta Research Institute Haina Precision Machining Center, Jiaxing 314000, Zhejiang, China

摘要

摘要: 旋磨术是治疗血管钙化病变的一种微创技术，通过微型砂轮去除堵塞在血管内的钙化斑块组织，达到疏通血管、重建血液流动的目的。钙化斑块组织堵塞血管造成供血不足，易诱发多种心血管疾病，其硬度较大导致球囊和支架无法撑开，目前临床上普遍采用旋磨术进行疏通。首先综述了旋磨术的相关研究成果和发展趋势，并对旋磨器械发展进行了介绍；其次总结了旋磨术优劣势的相关内容；然后对旋磨机理进行了详细的分析；最后总结了旋磨术目前存在的不足与未来的研究方向。
- 旋磨术 /
- 旋磨装置 /
- 旋磨机理 /
- 差异切削 /
- 并发症
Abstract: Significance Plaques are clogging deposits formed by the accumulation of fat and calcium on the inner walls of arteries. Their formation can lead to narrowing the inner diameter of the blood vessel and hardening the blood vessel wall, thereby limiting blood flow and inducing various cardiovascular diseases such as coronary heart disease and peripheral arterial disease. Numerous factors, such as lifestyle changes and population aging, have lead to an increase in the number of patients with cardiovascular disease in China in recent years. The annual growth rate of vascular interventional therapy has remained at around 17% for a decade due to the continuous development of interventional medical means. China's large population of vascular disease and the special situation of calcified plaque lesions have created a huge demand for rotational interventional therapy. By analyzing the current research on rotary grinding, this paper summarizes the existing deficiencies and suggests a follow-up research direction to accelerate the exploration of rotary grinding's mechanism and master the core technology theory. Progress: Firstly, the research on rotary grinding instruments is summed up in three parts: (1) The rotary grinding therapeutic apparatus mentioned here contains a description of its basic features, including the RA from Boston Science and the OA from CSI. The differences between the two were compared in terms of technical indications, clinical indications, mechanism of action, and product upgrades. (2) The preparation method for the grinding wheel and the differential cutting of the grinding wheel are presented in summary. Currently, grinding wheels are mostly created by electroplating, and some experts have suggested using the "engraving" technique. Differential grinding wheel cutting involves two primary principles. Boston Science proposed differential cutting that utilizes the theory of workpiece deformation during the cutting process of flexible materials. The second mechanism is based upon the theory of the dynamic pressure film in water. (3) A summary was provided regarding the structure and techniques of two different types of special rotary grinding guide wires, as well as the potential negative consequences during operation. Secondly, the differences between treatments are compared, such as rotational atherectomy, conventional balloon stenting, rotational resection, ELCA and shock wave balloon. The advantages of plaque rotary grinding are explained in detail. The likelihood of occurrence, explanations, methods of treatment, and other research on complications following rotational grinding are evaluated and summarized. Slow/non-reflow, vascular dissection, vascular perforation, grinding head incarceration, guide wire bias, etc., are all included. Engineering proposes controlling grinding parameters and improving the performance of related equipment to reduce the probability of complications. Finally, the research related to the mechanism of rotary grinding is examined. The main factors are rotary grinding force, rotary grinding heat, and rotary grinding debris. The grinding force is analyzed in a specific way by the current research, which focuses on the impact of grinding wheel speed and quality, blood vessel diameter, fluid dynamic pressure, and other factors on the grinding force. Research on rotary grinding heat focuses on reducing temperature through liquid scrubbing, but there is limited attention paid to thermal damage from an engineering perspective. The analysis of the wear debris mostly discusses the relationship between the size and the speed of the grinding wheel. Conclusions and Prospects (1) At present, the rotary grinding device and related consumables are all imported from the United States. In the future, Chinese substitution will be an important development direction. The development of Chinese rotary grinding products is under process now. (2) The study of the differential cutting mechanism and the design of the surface characteristics of the rotary grinding head to achieve non-invasive vascular tissue removal and efficient plaque tissue removal plays an important role in reducing other injuries caused by surgery. (3) The safety of the grinding process could be improved by optimizing the grinding parameters. There are few discussions on whether other factors in the grinding process will affect parameters such as grinding force, grinding debris and grinding heat. This is the direction of continuous research. (4) There are few theoretical studies on the grinding guide wire, and the performance of the guide wire is the main factor in determining whether it is biased or broken during the operation. Explore the possibility of processing different materials into high-performance grinding guide wires and new processing methods. On the premise of ensuring product performance, minimizing device costs and surgical costs is also a key research direction in the future. (5) According to the characteristics of plaque removal, the development of new products with better performance, such as laser plaque ablation products, shock wave balloons, etc., is also very marketable.
- rotational atherectomy /
- rotary grinding device /
- rotary grinding mechanism /
- differential cutting /
- complications

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图 1 钙化斑块的形成过程和旋磨去除

Figure 1. Formation process and rotary grinding removal of calcified plaque

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图 2 旋磨装置

Figure 2. Rotary grinding device

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图 3 旋磨砂轮的制备^[11-12]

Figure 3. Preparation of rotational grinding wheel^[11-12]

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图 4 基于形变理论的差异切削

Figure 4. Differential cutting based on deformation theory

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图 5 旋磨导丝^[19-20]

Figure 5. Rotary grinding guide wire^[19-20]

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图 6 部分斑块的治疗方法

Figure 6. Some treatments of plaque

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图 7 旋磨术体外试验平台^[67]

Figure 7. Rotary grinding in vitro test platform^[67]

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图 8 旋磨参数对磨削力的影响^[74]

Figure 8. Influence of the grinding parameters on the grinding force^[74]

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图 9 热成像检测温度变化

Figure 9. Thermal imaging detects temperature changes

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图 10 旋磨热模型^[80-81]

Figure 10. Rotary grinding heat model^[80-81]

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图 11 旋磨参数与磨屑尺寸的关系^[74,83,85]

Figure 11. Relationship between grinding parameters and debris size^[74,83,85]

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表 1 RA与OA对比

Table 1. Comparison of RA and OA

分类	比较项目	OA	RA
技术指征	旋磨砂轮	双向磨削	单向磨削
	旋磨砂轮	1.25 mm砂轮处理较大直径的斑块	多个尺寸( 8个)， 1.25 ～2.05 mm
	导丝	ViperWire	RotaWire
	动力源	电子系统	气动系统
	转速	80 000～120 000 r/min	140 000～ 190 000 r/min
作用机理	旋转方式	公转 + 自转	自转
	旋转方式	偏心安装的金刚石砂轮利用离心力做轨道运动	金刚石磨头尖端在导丝上同心旋转
	去除方式	砂轮磨削	砂轮磨削
临床指征		导丝可通过严重钙化的冠状动脉病变，不适合多次更换旋磨砂轮的情况	导丝穿过较困难时，采用小直径砂轮开通闭塞病变

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表 2 旋磨术并发症

Table 2. Rotary grinding complications

并发症	图片	产生原因	处理方法
慢血流/无复流^[40-43]		·血小板聚集，血栓形成 ·远端冠状动脉痉挛 ·旋磨头直径过大，转速快，病变长，单次旋磨时间过长	·维持动脉血压 ·使用冠状动脉血管扩张剂 ·冠脉内注射药物（硝酸甘油、维拉帕米） ·使用小尺寸砂轮和较低速度
血管夹层^{[41, 44-46]}		·磨头过大，推进速度过快 ·转速过高、旋磨次数过多	·停止旋磨 ·保持导丝位置而后使用血管成形术等方法治疗
血管穿孔^{[41, 44-46]}		·病变严重成角 ·旋磨头过大 ·导丝偏离 ·球囊尺寸或压力过大 ·支架尺寸或释放压力过大 ·不适当的手法	·尽量避免在病变严重扭曲的情况下使用 ·使用小尺寸砂轮和较低速度 ·紧急采用心包穿刺 ·采用球囊填充、覆膜支架等技术
旋磨头嵌顿^{[41, 47-49]}		·旋磨头离病变过近 ·转速过低（＜10 000 r/min） ·旋磨头在病变中间停顿 ·已发生痉挛或夹层的病变 ·未注入旋磨液	·来回拉动导丝 ·插入导管切割砂轮驱动轴 ·植入球囊扩张与砂轮相邻，扩张球囊以松动旋磨砂轮 ·取回失败时采用外科手术
导丝偏置和断裂^[50]		·弥漫、迂曲病变 ·导丝进入细小成角的血管分支 ·导丝弯曲、打折 ·导丝嵌顿后用力回撤	·送入另一根导丝，小球囊推送，以助导丝退出 ·经导管撤出旋磨导丝

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