准分子激光冠状动脉内斑块消蚀术对严重钙化冠状动脉病变的治疗作用  

The Treatment of Sever Coronary Calcification by Using Excimer Laser Atherectomy

作　　者：王天杰[1,2] 袁建松 张紫薇[2] 唐炯 郑甲林 白洁 杨伟宪 WANG Tian-jie;YUAN Jian-song;ZHANG Zi-wei;TANG Jiong;ZHENG Jia-lin;BAI Jie;YANG Wei-xian(Department of Cardiology,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China;Department of Cardiology,Fuwai Yunnan Cardiovascular Hospital,Kunming 650000,China)

机构地区：[1]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院冠心病中心,北京市100037 [2]云南省阜外心血管病医院冠心病中心,昆明市650000

出　　处：《中国分子心脏病学杂志》2021年第4期4076-4079,共4页Molecular Cardiology of China

摘　　要：目的评估准分子激光冠状动脉内斑块消蚀术(ELCA)治疗冠状动脉严重钙化病变的即刻效果和安全性。方法回顾性分析2020年5月至2020年12月在云南省阜外心血管病医院行介入治疗的冠心病患者中因合并严重钙化病变导致常规治疗失败转行ELCA的患者资料,分析ELCA的即刻成功率和并发症情况,并通过血管内超声(IVUS)评估钙化角度和ELCA后支架膨胀情况。支架膨胀不全定义为最小支架面积<4.5 mm^(2)且最小支架面积/参考血管面积<70%。结果共有7例严重钙化转行ELCA患者,平均年龄(65.3±7.0)岁,激光导管通过率100%,其中1例冠状动脉严重成角患者ELCA导管通过后造影提示冠状动脉穿孔,后终止手术予小球囊封堵后纠正,IVUS测量平均最大钙化角度为298.33°±86.35°,术后平均支架面积为(5.56±2.35)mm^(2),无支架膨胀不全发生,平均支架面积/参考血管面积为(87.64±9.39)%。结论ELCA对冠状动脉内严重钙化病变常规介入治疗失败的患者,可以提高手术成功率并有良好的即刻支架膨胀效果,但需注意严重成角的病变有冠状动脉穿孔的风险。Objective To evaluate the effectiveness and safety of excimer laser atherectomy(ELCA)in treating severe coronary artery calcification.Methods Patients with failed routine percutaneous coronary intervention caused by severe calcification and transferred to ELCA were analyzed in Fuwai Yunnan Hospital.The successful rate and complication of ELCA were evaluated.Calcification arc and stent expansion were analyzed by intravascular ultrasound.Stent under expansion was defined as minimal stent area<4.5 mm^(2) and minimal stent area/reference lumen area<70%.Results From May 2020 to Dec 2020,7 patients was enrolled[mean age 65.3±7.0 years old].Laser catheter pass rate was 100%.One patient with angled calcification had coronary perforation after ELCA and was cured by small balloon obstruction.Intravascular ultrasound showed the mean calcification arc was(298.33±86.35)°and the mean stent area was(5.56±2.35)mm^(2).No stent under expansion was found.The ratio of minimal stent area/reference lumen area was(87.64±9.39)%.Conclusion ELCA could facilitate the failed severe calcification with well stent expansion.However,coronary perforation should be cautious in angled artery during ELCA.

关 键 词：经皮冠状动脉介入治疗 准分子激光冠状动脉内斑块消蚀术 冠状动脉穿孔 

分 类 号：R541.4[医药卫生—心血管疾病]