新型准分子激光冠状动脉斑块消融术在冠状动脉钙化及慢性阻塞性病变中的初步应用  

Preliminary experience of percutaneous coronary intervention for calcified lesions and chronic total occlusions using excimer laser coronary atherectomy as an adjunctive modality

作　　者：杜俣 刘巍[1] 周玉杰[1] 赵迎新[1] 郭永和[1] 史冬梅[1] 刘宇扬[1] 周志明[1] 成万钧[1] 葛海龙[1] 王志坚[1] 张建维[1] 王建龙[1] 刘睿方[1] 胡宾[1] 刘晓丽[1] Du Yu;Liu Wei;Zhou Yujie;Zhao Yingxin;Guo Yonghe;Shi Dongmei;Liu Yuyang;Zhou Zhiming;Cheng Wanjun;Ge Hailong;Wang Zhijian;Zhang Jianwei;Wang Jianlong;Liu Ruifang;Hu Bin;Liu Xiaoli(Department of Cardiology,Beijing Anzhen Hospital affiliated to Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心内科,100029

出　　处：《中华心血管病杂志（网络版）》2019年第1期123-132,共10页Chinese Video Journal of Cardiology

基　　金：国家重点研发计划“精准医学研究”重点专项(2017YFC0908800);北京市医院管理局“登峰”计划(DFL20150601);北京市医院管理局临床医学发展专项(ZYLX201303)。

摘　　要：目的总结应用新型准分子激光冠状动脉斑块消融术(excimer laser coronary atherectomy,ELCA)治疗冠状动脉钙化病变及慢性完全阻塞(chronic total occlusion,CTO)病变的初步经验。研究对象本研究为横断面、单臂、观察性试验,连续入选2015年3月至2017年12月于首都医科大学附属北京安贞医院心内科采用ELCA行经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)的复杂冠状动脉疾病患者106例(111处病变)。男性85例,女性21例,年龄(62.5±10.8)岁,不稳定心绞痛患者79例,占74.5%。病变类型为冠状动脉钙化病变(73处,65.8%)或CTO病变(38处,34.2%),所有病变均为经过常规处理后球囊不能通过(52处,46.8%)或不能扩张(59处,53.2%)病变。干预措施共111处病变(106例患者)拟在常规PCI基础上行ELCA辅助治疗,随后行冠状动脉支架置入或药物球囊扩张。89处(80.2%)病变应用直径0.9 mm激光导管,22处(19.8%)病变应用直径1.4 mm激光导管进行斑块消蚀。能量为(52.0±7.5)mJ/mm^(2),范围为(45~60)mJ/mm^(2),频率为(49.0±21.3)Hz,范围为(25~80)Hz,消融次数为(3.0±1.6)次。观测指标及测量方法主要观察指标为手术即刻成功率、术中并发症发生率和1个月时临床成功率。手术即刻成功定义为术中由血管造影证实使用ELCA后球囊可通过并扩张病变血管,PCI术后靶病变残余狭窄<50%,溶栓试验血流分级(thrombolysis in myocardial infarction,TIMI)3级且无术中并发症。术中常见并发症包括冠状动脉血栓形成、无复流、夹层、急性闭塞和穿孔等。临床成功为手术即刻成功且术后1个月无主要不良事件发生。主要不良事件包括全因死亡、非致死性心肌梗死和靶血管再次血运重建。结果106例患者共111处病变拟行ELCA治疗,104处病变(99例患者)成功通过激光导管后行球囊扩张,其中92处病变置入药物洗脱支架,12处病变行药物球囊扩张。7例患者(7处病变)因激光导管未能通过Objective To report the preliminary experience of using excimer laser coronary atherectomy(ELCA)as an adjunctive modality for percutaneous coronary intervention(PCI)of calcified lesions and chronic total occlusions(CTO).Subjects As a cross-sectional,single-arm and observational designation,106 patients(111 lesions)with PCI for calcified lesions or CTO using ELCA as an adjunctive modality were enrolled from March 2015 to December 2017 in Beijing Anzhen Hospital affiliated to Capital Medical University.The mean age of the patients was(62.5±10.8)years;85 cases were men,21 cases were women,and 74.5%(79/111)presented with an unstable angina.All the indicated lesions were non-crossable(52 places,46.8%)or non-expandable(59 places,53.2%)with traditional strategies,consisting of calcified lesions(73 places,65.8%)and CTO(38 places,34.2%).Interventions A total of 106 patients were pre-treated with ELCA during CTO standard procedure followed by drug-eluting stent or drug-coated balloon.Two types of rapid exchange catheter were used during ELCA.Of the total 111 lesions,89 lesions(80.2%)were treated with catheter of 0.9 mm and 22 lesions(19.8%)were treated with catheter of 1.4 mm.The maximum energy was(52.0±7.5)mJ/mm^(2) with the scope from 45 to 60 mJ/mm^(2).The maximum frequency was(49.0±21.3)Hz with the scope from 25 to 80 Hz.Each patient were treated with ELCA about three times.Main Outcomes and Measurements The primary outcomes were immediate procedural success,intraprocedural complications,and clinical success at 1 month after the procedure.Immediate success was defined as angiogram-confirmed lesions that can be passed and expanded by balloon after the use of ELCA,residual stenosis of target lesions less than 50%after PCI,thrombolysis in myocardial infarction(TIMI)grade 3 without intraprocedural complications.Common complications during ELCA treatment were coronary thrombosis,no-reflow,dissection,acute vessel closure and perforation.Clinical success was defined as procedural success without major adeverse cardiac even

关 键 词：激光 准分子 冠状动脉疾病 动脉粥样硬化 血管成形术 经腔 经皮冠状动脉 

分 类 号：R54[医药卫生—心血管疾病]