准分子激光冠状动脉斑块消蚀术治疗复杂冠状动脉病变的临床观察

Clinical Observation of Excimer Laser Coronary Atherectomy in the Treatment of Complex Coronary Artery Lesions

目的:探讨准分子冠状动脉斑块消蚀术(ELCA)治疗复杂冠状动脉病变的安全性和有效性。方法:回顾性分析2018年5月至2023年8月在我院采用ELCA治疗的50例(53处病变)复杂冠状动脉病变患者,观察ELCA的疗效和安全性,术后对患者进行定期随访,观察主要不良心脑血管事件发生的情况。结果:53处病变中4处因重度钙化,0.9 mm激光导管未能通过,ELCA治疗成功率为92.5%(49/53)。ELCA术后1处病变靶血管严重夹层、2处病变残余病变仍>30%,PCI手术即刻成功率为86.8%(46/53)。术后24 h有1例患者出现急性支架内血栓形成,急诊行血栓抽吸术后恢复,其余患者围术期无并发症发生。术后随访7(5~10)月,1例患者在术后1周因急性脑梗死致死,其余患者未发生主要不良心脑血管事件。结论:ELCA是治疗高阻力复杂冠状动脉病变的一种安全、有效的介入手段。

Objective To investigate the safety and efficacy of excimer laser coronary atherectomy(ELCA)in the treatment of complex coronary artery lesions.Methods Fifty cases(53 lesions)of complex coronary artery lesions treated with ELCA in our hospital from May 2018 to August 2023 were retrospectively analyzed to observe the efficacy and safety of ELCA.Regular follow-up was conducted post-surgery to monitor major adverse cardiovascular and cerebrovascular events(MACCEs).Results Of the 53 lesions,4 lesions were severely calcified,and a 0.9 mm laser catheter could not pass through,resulting in a success rate of 92.5%(49/53)for ELCA treatment.Post-ELCA,one lesion had severe dissection of the target vessel,and two lesions had residual stenosis of>30%.The immediate success rate of PCI surgery was 86.8%(46/53).Within 24 hours post-surgery,one patient experienced acute intrastent thrombosis,which was resolved after emergency thrombus aspiration,and no other complications occurred during the perioperative period.During the follow-up period of 7(range:5-10)months post-surgery,one patient died due to acute cerebral infarction in the first week post-surgery,while the remaining patients did not experience major adverse cardiovascular and cerebrovascular events.Conclusion ELCA is a safe and effective interventional method for treating high-resistance complex coronary artery lesions.