准分子激光消蚀术在支架内再狭窄病变中的应用  

In-stent restenosis lesions treated by excimer laser coronary atherectomy

作　　者：李辉[1] 夏博 米秀青 郑耐心[1] 艾虎[1] 唐国栋[1] 张慧平[1] 杨国建[1] 赵迎 孙福成[1] LI Hui;XIA Bo;MI Xiuqing;ZHENG Nai-xin;AI Hu;TANG Guo-dong;ZHANG Hui-ping;YANG Guo-jian;ZHAO Ying;SUN Fu-cheng(Department of Cardiology,Beijing Hospital,Beijing 100730,China)

机构地区：[1]北京医院心内科国家老年医学中心中国医学科学院老年医学研究院,北京100730 [2]冠县人民医院心内科

出　　处：《中国介入心脏病学杂志》2020年第8期425-429,共5页Chinese Journal of Interventional Cardiology

基　　金：2017年首都特色临床特色应用研究与成果推广项目(Z71100001017202)。

摘　　要：目的评估准分子激光消蚀术在支架内再狭窄病变治疗中的疗效和安全性。方法回顾性分析从2017年12月至2018年12月在北京医院应用准分子激光消蚀术治疗的支架内再狭窄患者共11例,其中4例(4/11)为慢性完全闭塞病变。11例患者根据参考血管直径、血管狭窄程度选择不同直径的激光导管消蚀病变,后续采用球囊扩张、药物洗脱球囊和(或)药物洗脱支架完成最终治疗。应用定量冠状动脉造影在激光治疗前、激光治疗后及最终影像结果进行最小管腔直径的测量,所有的患者住院期间监测治疗效果,并进行了术后9个月的临床电话随访。结果11例患者均取得了即刻手术成功,激光治疗后最小管腔直径较治疗前增加[1.37(1.00,2.40)mm比0.76(0.10,2.31)mm,P<0.05]。所有患者术中未发生急性血管闭塞、血管夹层。有2例(2/11)患者出现了EllisⅡ型冠状动脉穿孔,未采取任何特殊处理且病情稳定。住院期间无死亡及靶病变血运重建发生。9个月随访时所有患者无死亡、心肌梗死发生,但是仍有2例(2/11)患者进行了靶病变血运重建治疗。结论准分子激光消蚀术对于复杂的支架内再狭窄病变是一项安全有效的治疗措施。单纯准分子激光消蚀治疗可以明显增加残余管腔直径,可取得满意的术后即刻及9个月治疗效果。Objective To investigate the efficiency and safety of excimer laser coronary atherectomy(ELCA)used in in-stent restenosis lesions.Methods From December 2017 to December 2018,11 patients treated by ELCA for in-stent restenosis in Beijing hospital were included in this study,4 of them(4/11)were chronic total occlusions.The size of laser catheters was selected according to the diameter of the vessels and stenosis percentage,then subsequent treatment with balloon angioplasty,drug eluting balloons and/or drug eluting stents.Quantitative coronary angiography(QCA)was used to measure the diameter of the vessels before ELCA,after ELCA,and the fi nal coronary angiography.All of the patients were observed during hospitalization,and followed up for 9 months by phone.Results All of the patients got procedure success after operation,the average minimal lumen diameter increased from 0.76(0.10,2.31)mm to 1.37(1.00,2.40)mm(P<0.05)after ELCA.There was no acute vessel closure,no dissection,but 2 perforations(type EllisⅡ)without special further treatment.There was no death or target lesion revascularization during hospitalization.At 9 months follow-up,there was also no death,myocardial infarction,but two events of target lesion revascularization(2/11).Conclusions ELCA is an effi cient and safe treatment for complex in-stent restenosis lesions,ELCA can increase the diameter of the vessels obviously,and can achieve satisfi ed immediate and 9 months results.

关 键 词：准分子激光消蚀术 支架内再狭窄 

分 类 号：R542.2[医药卫生—心血管疾病]