准分子激光冠状动脉内斑块消蚀术在大隐静脉桥血管病变介入治疗中的应用分析

Safety and Efficacy of Excimer Laser Coronary Angioplasty in the Percutaneous Coronary Intervention of Saphenous Vein Graft Lesion

目的:观察准分子激光冠状动脉内斑块消蚀术(ELCA)在冠状动脉旁路移植术后大隐静脉桥血管(SVG)病变经皮冠状动脉介入治疗(PCI)中应用的安全性和有效性。方法:总结2020年5月至2021年5月在云南省阜外心血管病医院冠心病中心应用ELCA治疗的5例大隐静脉桥血管病变PCI患者,导引钢丝通过SVG病变,应用血管内超声评价SVG病变特征,ELCA治疗后进行药物洗脱支架置入或药物洗脱球囊处理。观察手术成功率及并发症,并随访复发性心绞痛、心肌梗死、靶血管重建及心原性死亡等主要不良心脏事件(MACE)发生情况。结果:5例患者ELCA辅助SVG病变PCI全部成功,术中无1例发生血管夹层、穿孔、慢血流及无复流,随访期间无1例发生复发性心绞痛、心肌梗死、靶血管重建及心原性死亡。结论:应用ELCA辅助SVG病变行PCI安全有效,可显著减少相关并发症,改善预后。

Objectives: To evaluate the safety and efficacy of excimer laser coronary angioplasty(ELCA) in the percutaneous coronary intervention(PCI) of saphenous vein graft(SVG) lesion.Methods: 5 patients with severe SVG lesions were pretreated with ELCA, followed by routine PCI in Fuwai Yunnan Cardiovascular Hospital. SVG lesions and the final treatment results were analyzed by intravascular ultrasound(IVUS). The procedure success rate and complications were observed and the incidence of major adverse cardiovascular events(MACE)was observed during follow-up period.Results: ELCA-assisted PCI for the treatment of SVG lesions were successful in all 5 patients. No coronary dissection,perforation, slow-flow or no-reflow occurred during the procedure;no angina, myocardial infarction, target vessel revascularization or cardiac death was observed during the follow-up period(case 1 and 2 up to 18 months, case 3 and 4 up to 12 months and case 5 up to 6 months post procedure).Conclusions: Application of ELCA prior to routine PCI is safe and effective for the treatment of severe SVG lesions and related to a lower complication rate.