血管内碎石术在非ST段抬高型急性冠状动脉综合征合并钙化病变患者经皮冠状动脉介入治疗术中的有效性和安全性  

Efficacy and safety of intravascular lithotripsy in percutaneous coronary intervention in patients with non-ST elevation acute coronary syndrome with calcified lesions

作　　者：晋辉[1] 孙红蕾 韦艳[1] 王中明[1] 曾辉[1] 刘静[1] 周庆庆 尹遇冬[1] 郑海军[1] JIN Hui;SUN Hong-lei;WEI Yan;WANG Zhong-ming;ZENG Hui;LIU Jing;ZHOU Qing-qing;YIN Yu-dong;ZHENG Hai-jun(Department of Cardiology,Jiaozuo People’s Hospital,Henan Province,Jiaozuo Key Laboratory of Myocardial Microcirculation,Jiaozuo 454002,China;Department of Cardiology,Central Hospital of Jiaozuo Coal Industry Group,Jiaozuo 454002,China)

机构地区：[1]河南省焦作市人民医院心内科,焦作市心肌微循环医学重点实验室,河南省焦作市454002 [2]焦作市煤业集团中央医院心内科

出　　处：《中国心血管病研究》2024年第2期167-171,共5页Chinese Journal of Cardiovascular Research

基　　金：河南省焦作市2022年科技计划项目支持(20223005)。

摘　　要：目的观察血管内碎石术(intravascular lithotripsy,IVL)在非ST段抬高型急性冠状动脉综合征(non-segment elevation acute coronal syndrome,NSTE-ACS)合并钙化病变患者经皮冠状动脉介入治疗(percutaneous coronary intervention,PCI)术中的临床疗效。方法回顾性分析2022年10月至2023年4月期间在焦作市人民医院和焦作市煤业集团中央医院接受IVL治疗的所有患者。收集患者的人口统计学特征、临床数据、手术操作具体数据及相关并发症,观察IVL的有效性和安全性。结果43例患者在此期间接受IVL辅助PCI,年龄(67.77±7.21)岁。76.7%的患者为不稳定型心绞痛,23.3%的患者为急性非ST段抬高型心肌梗死患者。26例(60.5%)为原位病变,11例(25.6%)为支架内再狭窄,6例(13.9%)为支架膨胀不全“补救”治疗。手术成功率为100%。支架植入/DCB后狭窄率为(3.372±4.040)%,最小管腔面积为(9.416±0.940)mm^(2)。围术期有1例患者出现慢血流,围术期主要心血管不良事件(MACE)发生率为16.7%,均为手术相关性心肌梗死,共7例。术后30 d无MACE发生。结论IVL是一种安全有效的修饰冠状动脉钙化以实现支架充分膨胀的新方法。Objective To observe the clinical efficacy of intravascular lithotripsy(intravascular lithotripsy,IVL)in percutaneous coronary intervention(percutaneous coronary intervention,PCI)in patients with non-ST elevation acute coronary syndrome with calcified lesions.Methods All the patients treated with IVL in the Department of Jiaozuo People’s Hospital and Jiaozuo Central Hospital of Coal Industry Group from October 2022 to April 2023.Patient demographic characteristics,clinical data,specific procedure data and related complications were collected to appraise the efficacy and safety of IVL.Results Forty-three patients received PCI with adjuvant IVL during this period,and the mean age was(67.77±7.21).The proportion of the patients with unstable angina was 76.7% and 23.3% with NSTEMI.60.5% was in situ lesion,25.6% was in-stent restenosis,and 13.9% was“salvage”treatment with incomplete stent inflation.The surgical success rate was 100%.After stenting or DCB implantation,the restenosis rate was(3.372±4.040)% and the minimum lumen area was(9.416±0.940)mm^(2).One patient had slow flow during the perioperative period.The perioperative MACE incidence was 16.7%,all of which were surgery-related myocardial infarction,totaling 7 cases.Conclusions IVL is a safe and effective new method to modify coronary artery calcification to achieve adequate stent expansion.

关 键 词：经皮冠状动脉介入治疗 冠状动脉钙化 血管内碎石术 冠状动脉原位病变 支架内再狭窄 

分 类 号：R541.4[医药卫生—心血管疾病]