准分子激光冠状动脉成形术在慢性完全闭塞高阻力病变介入治疗的有效性及安全性

Efficacy and safety of Excimer laser coronary angioplasty for the treatment of resistant chronic total occlusion lesions

目的观察准分子激光冠状动脉成形术(excimer laser atherectomy,ELCA)在慢性完全闭塞(chronic total occlusion,CTO)高阻力病变中的应用的安全性和有效性。方法总结自2020年5月至2021年8月在云南省阜外心血管病医院冠心病中心应用CTO导丝通过后球囊无法通过的病例共计51例,其中22例应用ELCA,29例采用其他临床常规方法,病例成功后均行血管内超声检查评估CTO段斑块性质并优化PCI治疗结果。手术成功定义为ELCA治疗后球囊及后续支架可通过病变,且支架植入后残余狭窄<20%。结果手术总成功率为90.2%(46/51),ELCA组成功率为100%(22/22),非ELCA治疗组成功率为82.7%(24/29),2组患者均未发生血管穿孔、心包填塞并发症。结论应用ELCA辅助CTO高阻力病变PCI治疗是安全有效的,可显著提高手术成功率。

Objective To assess the efficacy and safety of Excimer laser coronary atherectomy(ELCA)in the treatment of resistant chronic total occlusion(CTO)lesions.Methods Fifty-one patients with severe resistant CTO lesions in Fuwai Yunnan Cardiovascular Hospital during May 2020 and August 2021 were included in the study,22 of them treated with ELCA and 29 with routine PCI.The plaque characters were analyzed and the final treatment effects were optimized by intravascular ultrasound(IVUS)after the successful procedures by which the balloons as well as the follow-up stents successfully went through the lesions and the residual stenosis was less than20%.Results The total success rate of the two groups were 90.2%(46/51),that of the ELCA group reached 100%(22/22)and that of the non-ELCA group 82.7%(24/29).Neither coronary perforation nor acute cardiac tamponade occurred during the operation in both the groups.Conclusion ELCA is a valuable tool for the treatment of resistant CTO lesions.It helps to achieve optimal outcomes for the patients with severe resistant CTO lesions.