准分子激光冠脉斑块消融术在复杂冠脉病变中的临床应用  

Clinical application of excimer laser coronary atherectomy in complex coronary artery lesion

作　　者：戴心怡 丁澍[2] DAI Xinyi;DING Shu(School of Medicine,Jiangsu University,Zhenjiang Jiangsu 212013;Department of Cardiology,Affiliated Hospital of Jiangsu University,Zhenjiang Jiangsu 212001,China)

机构地区：[1]江苏大学医学院,江苏镇江212013 [2]江苏大学附属医院心内科,江苏镇江212001

出　　处：《实用心电学杂志》2021年第2期135-139,共5页Journal of Practical Electrocardiology

基　　金：镇江市重点研发计划(社会发展)项目(SH2019072)。

摘　　要：近十年来随着设备和技术的改良(低波长、低脉冲能量、肝素盐水灌注技术和多种尺寸导管的设计),准分子激光冠状动脉斑块消融术(excimer laser coronary atherectomy,ELCA)被越来越多地应用于复杂冠状动脉病变的辅助治疗中。ELCA通过光化学、光热及光机械作用消蚀动脉斑块,从而扩大动脉管腔面积。光学相干断层扫描成像显示,ELCA最重要的机制是组织消蚀、促进压力传递到血管和组织压缩。此外,激光脉冲会削弱组织之间的连接,从而促进组织拉伸。目前ELCA主要应用于慢性完全闭塞病变、严重钙化病变、严重支架内再狭窄、球囊无法通过或支架(球囊)膨胀不全、隐静脉桥血管和急性血栓等复杂冠状动脉病变,在提高经皮冠状动脉介入治疗成功率的同时亦减少了并发症的发生,在治疗复杂和难治性冠脉病变方面显示出了显著优势。In the last decade,with the improvement of equipments and techniques(low wavelength,low pulse energy,Heparin saline infusion technique and design of catheter in multiple sizes),excimer laser coronary atherectomy(ELCA)is increasingly used in the adjuvant treatment of complex coronary artery disease.ELCA dissolves arterial plaques by photochemical,photothermal and photomechanical processes to obtain larger arterial lumen area.Optical coherence tomography imaging demonstrates that the most important mechanism of ELCA is tissue ablation,facilitation of pressure delivery to the vessel and tissue compression.In addition,laser pulses could weaken the connection between tissues,and thus promote tissues to stretch.At present,ELCA is mainly applied in patients with chronic total occlusion,severe calcification lesions,severe in-stent restenosis,no access of balloon or stent(balloon)incomplete intumescence,and complex coronary artery lesions including saphenous vein graft disease and acute thrombotic disease.It not only improves the success rate of percutaneous coronary intervention,but also reduces the complications,which shows significant advantages in treating complex and refractory coronary artery diseases.

关 键 词：准分子激光冠脉消融术 复杂冠脉病变 经皮冠状动脉介入治疗 

分 类 号：R541.4[医药卫生—心血管疾病]