血管内碎石术处理冠心病患者经皮冠状动脉介入治疗中支架膨胀不全的效果  

Efficacy of Intravascular Lithotripsy in the Use of Stent Inflation During Percutaneous Coronary Intervention in Patients with Coronary Heart Disease

作　　者：周庆庆 李叙沅 孙红蕾 晋辉[1] 朱雅坤 韦艳[1] 杭晓阳 陈瑛 许华丽 王晓飞 郑海军[1] ZHOU Qingqing;LI Xuyuan;SUN Honglei;JIN Hui;ZHU Yakun;WEI Yan;HANG Xiaoyang;CHEN Ying;XU Huali;WANG Xiaofei;ZHENG Haijun(Cardiology,Jiaozuo People’s Hospital,Jiaozuo 454800,China;Intervention Department,Jiaozuo People’s Hospital,Jiaozuo 454800,China;Cardiology,Central Hospital of Jiaozuo Coal Industry Group,Jiaozuo 454001,China)

机构地区：[1]焦作市人民医院心内科,河南焦作454800 [2]焦作市人民医院介入科,河南焦作454800 [3]焦作市煤业集团中央医院心内科,河南焦作454001

出　　处：《河南医学研究》2025年第4期668-671,共4页Henan Medical Research

基　　金：河南省焦作市2022年科技计划项目支持(20223004)。

摘　　要：目的探讨血管内碎石术(IVL)在处理冠心病患者经皮冠状动脉介入治疗(PCI)中支架膨胀不全的临床疗效。方法本研究为回顾性研究,研究对象为2022年6月至2023年3月在焦作市人民医院和焦作市煤业集团中央医院接受PCI,术中因冠状动脉钙化且经高压非顺应性球囊或超高压非顺应性球囊扩张支架仍膨胀不全,并接受IVL治疗的心绞痛和非ST段抬高心肌梗死患者。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29例患者年龄(65.31±8.06)岁。17.24%的患者诊断为稳定型心绞痛,51.72%诊断为不稳定型心绞痛,31.03%诊断为急性非ST段抬高型心肌梗死。手术成功率为100%。IVL后靶病变钙化处支架内最小直径较IVL前增加(P<0.001)。IVL后靶病变钙化处支架内最小面积较IVL前增加(P<0.001)。IVL后钙化组织的钙化程度(角度)较IVL前降低(P<0.001)。围手术期仅有手术相关性心肌梗死,共6例,主要不良心血管事件(MACE)发生率为20.69%,无严重夹层、冠脉穿孔等并发症发生。随访6个月无MACE发生。结论在处理冠脉严重钙化病变时,支架植入后膨胀不全是不可完全避免的,使用IVL作为补救措施可能是一种有效且安全的方法。Objective To investigate the clinical efficacy of endovascular lithotripsy(intravascular lithotripsy,IVL)in percutaneous coronary intervention(PCI)in patients with coronary heart disease.Methods This study is a retrospective study.The subjects underwent PCI in Jiaozuo People’s Hospital and Central Hospital of Jiaozuo Coal Industry Group from June 2022 to March 2023,and the stent was still not fully dilated due to coronary artery calcification and high pressure non-compliant balloon expansion or ultra-high pressure non-compliant balloon expansion.Patients with angina pectoris and non-ST segment elevation myocardiol infarction received IVL.Patient demographic characteristics,clinical data,specific procedure data and related complications were collected to observe the effectiveness and safety of IVL.Results The average age of the 29 patients was(65.31±8.06)years,and 17.24%of patients was diagnosed stable angina,51.72%with unstable angina,and 31.03%with acute non-ST elevation myocardial infarction.The surgical success rate was 100%.The minimum stent diameter in the calcification of the target lesion after IVL increased compared with that before IVL(P<0.001).The minimum stent area in the calcification of the target lesion after IVL increased compared with that before IVL(P<0.001).The angle of the calcified tissue after IVL was reduced compared to that before IVL(P<0.001).There was only surgery-related myocardiol infarction,including 6 cases,and the incidence of major adverse cardiovascular events(MACE)was 20.69%,and no complications such as severe dissection and coronary perforation occurred.No MACE occurred at 6 months of follow-up.Conclusion In the treatment of severe calcification of coronary artery,incomplete expansion after stent implantation is inevitable,and the use of IVL as a remedy may be an effective and safe procedure.

关 键 词：冠状动脉钙化 经皮冠状动脉介入治疗 血管内碎石术 支架膨胀不全 

分 类 号：R543.31[医药卫生—心血管疾病]