经皮冠状动脉腔内冲击波球囊导管成形术在钙化小结中的应用效果:血管内超声评估

Application of coronary intravascular lithotripsy in calcified nodules:intravascular ultrasound description

目的探讨使用血管内超声(IVUS)评估经皮冠状动脉腔内冲击波球囊导管成形术(IVL)应用于钙化小结的有效性及安全性。方法共纳入2023年1月1日至5月31日郑州大学第一附属医院14例严重钙化患者,按有无钙化小结分为钙化小结组(8例)、无钙化小结组(6例)。对15支血管进行了IVL预处理,钙化小结血管组8支,无钙化小结血管组7支。患者均有IVL使用前及支架置入后的IVUS影像。主要有效性终点,在病变水平分析,钙化小结处与钙化角度最大处,支架置入后支架膨胀情况。次要有效性终点,在血管水平分析,比较钙化小结组与无钙化小结组支架置入术后的最小支架内面积。安全性终点,在支架置入术中有无介入并发症,包括严重血管夹层、血管急性闭塞、血管穿孔、慢血流、球囊破裂。结果在病变水平分析,对15支血管中的钙化病变进一步分组,病变中钙化小结有8处(钙化小结病变组),钙化角度最大处有15处(钙化角度最大病变组)。IVL使用前,钙化小结病变组管腔面积高于钙化角度最大病变组[3.68(3.19,5.13)mm^(2)比2.84(2.07,3.15)mm^(2),P=0.026],钙化小结病变组支架置入后同样部位面积增加低于钙化角度最大病变组[(2.43±1.65)mm^(2)比(4.57±1.75)mm^(2),P=0.009],但两组支架对称性、支架置入后管腔面积及支架膨胀系数比较,差异均无统计学意义(均P>0.05)。在血管水平分析,钙化小结血管组(7支)与无钙化小结血管组(6支)在支架置入后最小支架内面积比较,差异无统计学意义(P=0.578)。两组患者均无介入并发症发生。结论IVL对于钙化小结病变可以充分预处理,进而保证支架的膨胀及对称性,术中无严重介入并发症出现。IVL治疗钙化小结安全有效。

Objective Intravascular lithotripsy is a new technique for the treatment of severe calcifi ed lesions.The aim of this study is to validate the effi cacy and safety of intravascular lithotripsy in the treatment of calcifi ed nodules by IVUS.Methods A total of 14 patients with severe calcifi ed lesions were enrolled in this study.A total of 15 vessels were pretreated with IVL.The primary effi cacy endpoint was the stent expansion of the lesion at calcifi ed nodules and the largest angle of calcifi cation.Secondary effi cacy endpoint,at the vascular level,the minimum stent area was compared between the calcifi cation nodule group and the non-calcifi cation nodule group.The safety endpoint was absence of interventional complications,including severe vascular dissection,acute vascular occlusion,vascular perforation,slow fl ow,and balloon rupture.Results At the lesion level,before the use of IVL,the lumen area of calcifi ed nodules was higher than that of the maximum calcifi cation area[3.68(3.19,5.13)mm^(2)vs.2.84(2.07,3.15)mm^(2),P=0.026].The area of calcifi ed nodules and the maximum angle of calcifi cation in the same position after the use of stent increased[(2.43±1.65)mm^(2)vs.(4.57±1.75)mm^(2),P=0.009],but there was no signifi cant diff erence in stent expansion.At the vascular level,there was no signifi cant diff erence in the minimum stent area between the calcifi cation nodule group and the non-calcifi cation nodule group after stent implantation.No interventional complications occurred in the two groups.Conclusions For calcified nodules,IVL is a good pretreatment choice,then ensure the expansion and symmetry of the stent,and has no interventional complications.IVL is safe and eff ective for calcifi ed nodules.