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		<h1 class="catchCopy">ロータブレーターのエキスパートが教える合併症を避け，安全に行うためのガイド</h1>
		

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					著：坂倉建一（自治医科大学附属さいたま医療センター循環器内科准教授）
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				<ul class="property"><li class="disc">B5判・80頁・4色刷</li><li class="disc">ISBN&nbsp;978-4-8306-1944-1</li><li class="disc">2018年9月6日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">ロータブレーターを安全に行うために，適応，禁忌，画像機器の活用の仕方，合併症の種類や，対処法，予防法について解説した実践書．ロータブレーターは重篤な合併症が多いという負のイメージがあるが，本書では正しい知識，安全な治療戦略が具体的に記載されており，合併症発生を大幅に減らすことのできる工夫がエビデンスを交えて丁寧に解説されている．ロータブレーターのエキスパートである著者ならではのコツが豊富に盛り込まれた1冊．</section><section class="preface">はじめに<br><br>　ロータブレーターは経皮的冠動脈形成術（percutaneous coronary intervention：PCI）において，高度石灰化病変を治療するためのデバイスです．その有用性は広く知られていますし，「ロータブレーターがないと治療不可能な病変」があることはPCIに携わる術者間での共通認識であると思います．一方で，ロータブレーターには「合併症が多い」，「合併症が重篤」といった負のイメージがあるのも事実です．私はロータブレーターの合併症をゼロにすることはできないが，正しい知識や安全なstrategy を取れば，合併症発生を大幅に減らすことができると思います．そして正しい知識があれば，合併症が発生しても落ち着いて対応することが可能ではないかと思います．一方で，自分自身の行うロータブレーター手技にもまだまだ課題を感じており，どうすればもっと安全にロータブレーターを使うことができるのかをいつも考えてきましたし，今も考えています．ですので，本書はどうすればロータブレーターを安全に行うことができるかということにこだわって，執筆させていただきました．<br>　元来，ロータブレーターは石灰化病変に対するefficacyを求めるデバイスだと思いますが，私の中では常に「safety＞efficacy」です．もっと具体的に言うと，常に血管穿孔とバースタックを恐れつつ，穿孔させないように，バーをスタックさせないように慎重にロータブレーターを行っています．もし，読者の方が特別なテクニックを期待して本書を手に取っていただいたとしたら，私には特別なテクニックがあるわけではないので，期待外れに終わる可能性が高いでしょう．しかし，安全にロータブレーターを行うための考え方や工夫をこれまで発表してきた英文論文に用いた図やオリジナルのシェーマを用いて，できる限り詳細に盛り込みました．そういった考え方や工夫は特にロータブレーターをこれから始める先生やまだ経験の浅い先生にとって役に立つと考えています．<br>　本書を執筆することができたのは，上司の藤田英雄教授が出版社である文光堂に私を強く推薦してくださったのがきっかけです．病院長でもある百村伸一教授からは学術活動を含めて常にサポートしていただいています．埼玉メディカルセンター副院長の久保典史先生からはPCIおよびロータブレーターの基礎を教えていただきました．そして日々のロータブレーターを安全に行うことができたのは自治医科大学附属さいたま医療センターのスタッフ（循環器内科医師，臨床工学技士，放射線技師，カテ室看護師）の暖かいサポートのおかげです．この場を借りて，心から感謝申し上げます．<br><br>平成30年9月<br>坂倉建一</section><section class="indexes">1　ロータブレーターシステムおよび実際の手技について<br>　1　ロータブレーターシステム<br>　2　ロータブレーターの実際の手技<br>　　a　RotaWire<sup>TM</sup>の選択とその進め方<br>　　b　バーを病変部手前に持ち込む<br>　　c　バーで病変部を削る<br>　　d　polishing runは必要？<br>　　e　バーを体外に抜去する<br>　　　コラム1▶心臓外科医によるバックアップの重要性について<br>2　ロータブレーターの適応<br>　1　添付文書上の適応と禁忌<br>　2　実際の適応と禁忌<br>　　a　相対適応<br>　　b　絶対適応<br>　　c　禁忌<br>　　　コラム2▶ロータブレーターでも不可能はある<br>3　ロータブレーターに関するエビデンス<br>　1　適応病変に関するエビデンス<br>　2　ロータブレーターの方法に関するエビデンス<br>　　a　バーの大きさ<br>　　b　施行時の回転数<br>　　c　ロータカクテルの内容<br>　3　合併症の予測因子に関するエビデンス<br>　4　ロータブレーター後の予後に関するエビデンス<br>　　　コラム3▶精密機械なので，添付文書を守ることは大切<br>4　ロータブレーターにおけるイメージングデバイスの活用<br>　1　ロータブレーターにおけるイメージングデバイス<br>　2　IVUSの有用性<br>　　a　ロータブレーター施行前のIVUS<br>　　b　小さなバーでのアブレーション後のIVUS<br>　　c　ロータブレーター必要症例におけるIVUS<br>　　　コラム4▶calcified noduleへのロータブレーター<br>5　ロータブレーターを安全に行う工夫<br>　1　工夫①できるだけバーを強く押さない<br>　　a　ガイドカテーテルのバックアップが取れる形状を使用する<br>　　b　ガイドワイヤーを十分に末梢まで進める<br>　　c　最初は小さなバーから使用する<br>　　d　高リスク病変<br>　2　工夫②すべての石灰化部分をpassする必要はない<br>　3　工夫③長期の成績が良くなるに越したことはないが，まずは安全に初期成功を目指す<br>　　　コラム5▶ロータブレーターが使用できない施設において，石灰化に対してどこまで頑張るか<br>6　ロータブレーターにおける合併症：種類，対処法，予防法<br>　1　合併症①slow flow/no flow<br>　　a　どんなときに生じるか<br>　　b　どうやって対処するか<br>　　c　どうやって予防するか<br>　2　合併症②ガイドワイヤー断裂<br>　　a　どんなときに生じるか<br>　　b　どうやって対処するか<br>　　c　どうやって予防するか<br>　3　合併症③バーのスタック<br>　　a　どんなときに生じるか<br>　　b　どうやって対処するか<br>　　c　どうやって予防するか<br>　4　合併症④冠動脈穿孔<br>　　a　どんなときに生じるか<br>　　b　どうやって対処するか<br>　　c　どうやって予防するか<br>　　　コラム6▶ロータブレーターはチームプレーで<br>あとがき<br>索　引</section></article>
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