经皮冠状动脉腔内冲击波球囊导管成形术在血管内超声指导下对左主干重度钙化治疗的有效性和安全性分析  

Clinical study of percutaneous transluminal coronary intravascular lithotripsy angioplasty for severe left main coronary artery calcification guided by intravascular ultrasound percutaneous coronary

作　　者：刘丰齐 鲍骏 李拜红 陈翀昊 高长征[1] 过云峰[1] 顾鑫 顾建斌 王晓彦 LIU Feng-qi;BAO Jun;LI Bai-hong;CHEN Chong-hao;GAO Chang-zheng;GUO Yun-feng;GU Xin;GU Jian-bin;WANG Xiao-yan(Department of Cardiology,Affiliated Hospital of Jiangnan University,Wuxi 214000,China;Department of Cardiology,Huishan Second People’s Hospital,Wuxi 214000,China)

机构地区：[1]江南大学附属医院心内科,江苏无锡214000 [2]惠山区第二人民医院心内科,江苏无锡214000

出　　处：《中国介入心脏病学杂志》2024年第7期383-389,共7页Chinese Journal of Interventional Cardiology

基　　金：江苏省卫生健康委项目(ZDA2020023);无锡市卫生健康委项目(J202103);无锡市科技发展资金项目(N20202019);无锡市科技局医疗产业联合研究项目(5332207ZKJS)。

摘　　要：目的探讨经皮冠状动脉腔内冲击波球囊导管成形术或称血管内碎石术(IVL)在血管内超声(IVUS)指导下治疗左主干(LM)重度钙化病变的有效性和安全性。方法纳入2022年10月至2024年4月期间江南大学附属医院收治的26例LM(口部、体部、分叉)重度钙化患者,年龄72.0(61.8,75.4)岁。在IVUS指导下应用IVL对钙化病变进行预处理,再行经皮冠状动脉介入治疗(PCI)置入支架/药物球囊。所有患者均在应用IVL前后、PCI术后使用IVUS进行评估,并比较治疗前后IVUS腔内相关数据[斑块负荷(PB)、最小管腔面积(MLA)、最小管腔直径(MLD)]以及钙化断裂数、最小支架面积(MSA)、支架膨胀系数(EXP)等。结果26例患者(2例开口病变、7例体部病变、17例主干末端分叉病变)中稳定型心绞痛(SAP)7例,不稳定型心绞痛(UA)10例,急性ST段抬高型心肌梗死(STEMI)4例和非ST段抬高型心肌梗死(NSTEMI)5例。钙化最严重部位处PB在IVL后减小[79.50(76.00,83.75)%比80.00(76.00,83.75)%,P=0.001],MLA在IVL后增大[3.39(3.14,3.68)mm2比3.38(3.14,3.67)mm2,P=0.039],MLD在IVL后增大[3.21(3.07,3.30)mm比3.20(3.07,3.30)mm,P=0.024],100%有钙化环断裂(2例1个,9例2个,15例≥3个),100%成功置入支架/药物球囊,EXP高达(89.15±4.42)%,MSA 7.20(6.46,7.45)mm2。术后随访3个月均无心绞痛、复发性心肌梗死和死亡等不良事件发生。结论LM重度钙化病变经IVUS评估经IVL预处理后成功完成PCI术,IVL可作为LM重度钙化治疗的选择。Objective To explore the effectiveness and safety of percutaneous coronary artery shock wave balloon angioplasty(IVL)under the guidance of intravascular ultrasound(IVUS)for the treatment of severe calcification lesions in the left main artery(LM).Methods A total of 26 patients with severe LM(mouth,body,bifurcation)calcification admitted to Jiangnan University Affiliated Hospital from October 2022 to April 2024 were included,with an average age of 72.0(61.8,75.4)years.Under the guidance of IVUS,IVL was used for pre-treatment of calcified lesions,followed by percutaneous coronary intervention(PCI)with stent/drug balloon implantation.All patients were evaluated using IVUS before and after the use of IVL and after PCI.And compare the IVUS intracavity related data before and after treatment[plaque burden(PB)、minimum lumen area(MLA)、minimum lumen diameter(MLD)]and calcification fracture number,minimum stent area(MSA),stent expansion coefficient(expansion,EXP),etc.Results There were 26 patients(2 with opening lesions,7 with body lesions,and 17 with bifurcation lesions at the end of the main trunk),including 7 with stable angina pectoris(SAP),10 with unstable angina(UA),4 with acute ST-segment elevation myocardial infarction(STEMI),and 5 with non ST-segment elevation myocardial infarction(NSTEMI).The PB at the most severe site of calcification decreased by 79.50(76.00,83.75)%compared to 80.00(76.00,83.75)%after IVL(P=0.001),MLA increased by 3.39(3.14,3.68)mm2 compared to 3.38(3.14,3.67)mm2 after IVL(P=0.039),MLD increased by 3.21(3.07,3.30)mm compared to 3.20(3.07,3.30)mm after IVL(P=0.024),and there was 100%calcification rupture(1/2 cases,2/9 cases,≥3/15 cases).The stent/drug ball was successfully implanted 100%,with EXP of(89.15±4.42)%and an MSA of 7.20(6.46,7.45)mm2.No adverse events such as death,angina or recurrent myocardial infarction occurred during the 3 months follow-up after surgery.Conclusions After evaluation by IVUS and pre-treatment with IVL,PCI was successfully completed for severe calcification le

关 键 词：血管内碎石术 左主干 冠状动脉钙化 血管内超声 

分 类 号：R541[医药卫生—心血管疾病]