OCT指导冲击波碎石术治疗冠脉重度钙化病变的有效性及安全性研究  

Efficacy and safety study of OCT-guided shock wave lithotripsy in the treatment of severely calcified lesions of the coronary arteries

作　　者：周学敏 黄丽 陈宣兰 胡晶 谢耀武 张学洪[1] 尹秋林[1] 郭琴云 黄秀玲 Zhou Xuemin;Huang Li;Chen Xuanlan;Hu Jing;Xie Yaowu;Zhang Xuehong;Yin Qiulin;Guo Qinyun;Huang Xiuling(Jiangxi Provincial People's Hospital,Nanchang,Jiangxi 330038,China)

机构地区：[1]江西省人民医院,江西南昌330038

出　　处：《首都食品与医药》2025年第3期37-40,共4页Capital Food Medicine

基　　金：江西省卫生健康委科技计划项目(编号:202410130)。

摘　　要：目的研究光学相干断层扫描(OCT)指导冲击波碎石术治疗冠脉重度钙化病变的有效性及安全性.方法选择2024年1月-2025年12月期间在本院心内科住院的重度冠脉钙化患者70例,采用随机数表法分为对照(RA)组和试验(IVL)组,每组各35例.对照组采用传统斑块修饰技术冠状动脉内旋磨术(RA)治疗,试验组采用OCT指导下血管内冲击波碎石术(IVL)治疗,比较两组术后即刻成功率及并发症发生情况.结果RA组管腔面积、残余狭窄、最大钙化弧度、钙化长度比、最大钙化厚度显著高于IVL组,支架膨胀率小于IVL组,差异有统计学意义(P<0.05);IVL组植入成功率,残余狭窄<30%,靶病变处未出现明显夹层、穿孔、血栓,前向血流TIMI分级均高于RA组,差异有统计学意义(P<0.05);IVL组致死性心肌梗死、支架内血栓、靶血病变再次血运重建治疗发生次数均少于RA组,差异有统计学意义(P<0.05).结论IVL在即刻手术成功率、安全性及OCT检测即刻管腔面积获得等方面均不劣于RA,且在手术成功率及钙化最严重处支架植入后膨胀率优于RA,值得临床参考.Objective To study the efficacy and safety of optical coherence tomography(OCT)-guided shock wave lithotripsy in the treatment of severely calcified coronary lesions.Methods Seventy patients with severe coronary artery calcification who were hospitalized in our Department of Cardiology from January 2024 to December 2025 were selected.They were divided into 35 cases each in the control(RA)group and the experimental(IVL)group using a randomized numerical table.The control group was treated with traditional plaque modification technique of intracoronary rotary artery ablation(RA),and the experimental group was treated with OCT-guided intravascular shock wave lithotripsy(IVL),and the immediate postoperative success rate and the occurrence of complications were compared between the two groups.Results The lumen area,residual stenosis,maximum calcification arc,calcification length ratio,and maximum calcification thickness of the RA group were significantly higher than that of the IVL group,and the stent expansion rate was smaller than that of the IVL group,with statistically significant differences(P<0.05);the implantation success rate,residual stenosis of<30%,No obvious dissection,perforation,or thrombus appeared at the target lesion site,and antegrade TIMI grading of the forward flow of the IVL group were higher than that of the RA group,with statistically significant differences(P<0.05);the number of occurrence of fatal myocardial infarction,in-stent thrombus,and rehemodilution therapy of target blood lesion in the IVL group was less than that in the RA group,and the difference was statistically significant(P<0.05).Conclusion IVL is not inferior to RA in terms of immediate procedural success rate,safety,and immediate lumen area acquisition by OCT detection,and is superior to RA in terms of procedural success rate and post-stent implantation expansion rate at the most calcified site,which provides reference value for clinical.

关 键 词：OCT指导 冲击波碎石术 冠脉重度钙化 病变 有效性 安全性 

分 类 号：R543.3[医药卫生—心血管疾病]