冲击波球囊在急性ST段抬高型心肌梗死合并血栓负荷患者急性支架膨胀不全应用1例  

Under expanded stent of acute ST-segment elevation myocardial infarction with coronary thrombosis using intravascular lithotripsy:report of one case

作　　者：余东彪 马礼坤 胡昊[1] 孔祥勇 华锦胜 潘健源 杨光耀[2] 陈鸿武 YU Dong-biao;MA Li-kun;HU Hao;KONG Xiang-yong;HUA Jin-sheng;PAN Jian-yuan;YANG Guang-yao;CHEN Hong-wu(Department of Cardiology,the First Affiliated Hospital of China University of Science and Technology,Hefei 230001,China;Department of Cardiology,Bozhou People's Hospital,Bozhou 236800,China)

机构地区：[1]中国科学技术大学附属第一医院心血管内科,安徽合肥230001 [2]亳州市人民医院心血管内科,安徽亳州236800

出　　处：《中国介入心脏病学杂志》2025年第1期54-57,共4页Chinese Journal of Interventional Cardiology

摘　　要：冠状动脉钙化病变经常贯穿于各种复杂病变,增加了冠状动脉介入治疗的难度,尤其是重度钙化病变通常不能被充分扩张,导致手术成功率降低,急性或亚急性支架内血栓形成及再狭窄率增高,严重影响患者预后。随着经皮冠状动脉腔内冲击波球囊导管成形术(IVL)在钙化病变中使用越来越多。目前临床证据主要集中在稳定型心绞痛和不稳定型心绞痛的患者,但在急性ST段抬高型心肌梗死(STEMI)中应用有限,国外仅有个别病例报道,而且《冠状动脉钙化病变诊治中国专家共识(2021版)》将血栓病变列为IVL禁忌证。本病例是IVL在STEMI合并血栓病变中的紧急应用。本例STEMI合并血栓病变在支架置入后严重膨胀不良,探索住院期间强化抗凝治疗后,择期采用IVL处理,取得较好疗效。Coronary artery calcification often appears a variety of complex lesions,increasing coronary intervention of the difficulty of treatment,especially the severe calcification lesions,usually cannot be fully dilated,resulting in a reduced success rate of surgery,an increased rate of acute stent thrombosis and restenosis,and even a serious impact on the prognosis of patients.Intravascular lithotripsy(IVL)is increasingly used in calcified lesions.There is more and more evidence of using in stable angina pectoris and unstable angina pectoris,but its use in acute ST-segment elevation myocardial infarction is limited,and only a few cases have been reported abroad.Moreover,the consensus of Chinese experts in the diagnosis and treatment of coronary artery calcification in 2021 edition lists thrombotic lesions as contraindications of shock wave balloon.This case is the first time in China to report the use of shock wave balloon in patients with acute ST elevation myocardial infarction complicated with thrombus.In this case,the patient with acute ST elevation myocardial infarction complicated with thrombus was severely under expanded stent after stent implantation,and obtain good curative effect using shockwave balloon at selected time in hospital after intensive anticoagulant therapy.

关 键 词：钙化 急性心肌梗死 冲击波球囊 支架膨胀不良 

分 类 号：R54[医药卫生—心血管疾病]