准分子激光冠状动脉斑块消融术治疗复杂冠状动脉病变的近期临床效果观察

Short-term outcome of complex coronary lesions treated by excimer laser coronary atherectomy

目的探讨准分子激光冠状动脉斑块消融术治疗复杂冠状动脉病变的临床可行性、安全性和有效性。方法回顾性分析2017年7月24日至2018年8月24日在北京大学人民医院行准分子激光冠状动脉斑块消融术的全部患者22例,共有24处冠状动脉病变。这些病变类型包括反复支架内再狭窄、球囊无法通过或扩张的严重狭窄、无法行导丝交换的严重钙化、大隐静脉桥血管病变。术中联合血管内超声/光学相干断层成像、旋磨或其他常规介入治疗手段,置入或不置入支架。结果 24处病变手术即刻成功比例为23/24。未获即刻成功的1例患者为慢性完全闭塞病变,导丝成功通过后激光导管无法通过病变处,其他器械也无法通过。最终19/24的病变置入药物洗脱支架。术中无并发症发生,住院期间所有患者未发生主要不良心血管事件(包括死亡、急性ST段抬高型心肌梗死和冠状动脉穿孔导致急性心脏压塞)。结论准分子激光冠状动脉斑块消融术用于支架内再狭窄(尤其是反复再狭窄)、球囊无法通过或无法充分扩张的严重狭窄、无法进行导丝交换的严重钙化以及大隐静脉桥血管病变,可以为其他器械通过及支架置入创造条件,提高此类病变的手术成功率,临床操作简便,安全性较高,是一种有益的介入治疗手段。

Objective To investigate the feasibility,safety and efficacy of excimer laser coronary atherectomy used in complex lesions,including in-stent restenosis,non-crossable or nonexpandable lesions,heavily calcified lesions without successful wire-exchange and saphenous vein grafts lesions.Methods From Jul 24,2017 to Aug 24,2018,22 cases with 24 lesions were treated with excimer laser coronary atherectomy in Peking University People’s Hospital,combined with or without IVUS/OCT,rotational atherectomy or other percutaneous coronary intervention instrument,and with or without stent implantation.Results The procedural success rate was 23/24.There was no complications in all cases.Drug-eluting stents were implanted in 19/24 of lesions.There were no major advent cardiovascular events,including death,acute ST-segment-elevation myocardia and pericardial tamponade recorded.Conclusions Excimer laser coronary atherectomy used in complex lesions is feasible,safe and efficient with satisfactory in-hospital short-term outcome.