准分子激光冠状动脉成形术治疗支架内再狭窄

Treatment of In-stent coronary restenosis with excimer laser angioplasty

目的 评价准分子激光冠状动脉 (ELCA)加球囊成形术 (PTCA)治疗冠脉内支架再狭窄的有效性及安全性。方法 自 1996年 10月至 1998年 2月对 2 0例支架内再狭窄病人进行ELCA +PT CA治疗 ,其中男 17例、女 3例 ,平均年龄 (6 1± 8 7)岁。所有病人均有Ⅲ、Ⅳ级心绞痛 (加拿大心脏病协会分级 )。共有 2 3个支架 ,其中 2例病人为一根血管多个支架 ,支架直径为 2 5～ 3 5mm。选用同心型和偏心型激光导管 ,直径 1 4～ 2 0mm。激光能量范围为 40～ 6 0mJ/mm2 ,平均 (45 7± 5 5 )mJ/mm2 。所有病人于ELCA后行球囊成形术 ,球囊直径 2 5～ 4 0mm ,扩张压力为 (6～ 12 )atm ,平均 (7 8±2 0 )atm。结果 激光导管可顺利通过所有狭窄甚至闭塞病变。应用冠状动脉形象分析 (QCA)测量病变长度为 4 6～ 5 1 2mm ,平均 (2 0 7± 13 7)mm ,其中 14个病变≥ 10mm。ELCA后最小血管直径(MLD)自 (0 3± 0 3)mm增至 (1 4± 0 3)mm(P <0 0 0 0 1) ,血管狭窄程度自 (88 9± 10 ) %降至 (46 0±8 0 ) % (P <0 0 0 0 1)。球囊成形后使MLD进一步增加至 (2 3± 0 7)mm(P <0 0 0 0 1) ,血管狭窄程度降至 (14 2± 8 2 ) % (P <0 0 0 1)。所有病人手术成功 ,无严重并发症。 1例病人在ELCA +PTCA后效果不理想 。

Objective The purpose of present study was to evaluate the efficacy and safety of Excimer Laser Coronary Angioplasty (ELCA) with adjunctive balloon angioplasty in patient with instent restenosis Methods ELCA was performed in 20 patients of in sent restenosis All patients were symptomatic and had class Ⅲ Ⅳ angina The laser catheter of concentric and eccentric with diameter (1 4～2 0)mm was used Energy densities ranged from 40 to 60 mJ/mm 2, mean (45 7±5 5)mJ/mm 2 Results Laser catheter crossed all stenotic stents without difficulties The lesion length was (4 6～51 2)mm, mean (20 7±13 7)mm, included 14 lesions ≥10 mm Laser treatment alone increased minimal lumen diameter (MLD) from (0 3±0 3)mm to (1 4±0 3)mm ( P <0 000?1) and improved the diameter stenosis from (88 8±10 0)% to (46 0±8 0)% ( P <0 000?1) Adjunctive balloon angioplasty further increased minimal lumen diameter to (2 3±0 7)mm and reduced diameter stenosis to (14 2±8 2)% ( P <0 000?1) At follow up [(1～17) months, mean (8 9±5 7) months], 17 (85%) patients had remained asymptomatic, 3 (15%) patients had mild to moderate exertional angina, 1 (5%) patient was performed CABG Conclusion ELCA with adjunctive PTCA is an efficient and safe technique to debulk tissue in the patient with in stent restenosis The incidence of procedural related complication was low and ELCA may be used as a good method for in stent restenosis treatment