冲击波冠状动脉球囊在冠状动脉严重钙化病变介入治疗中的应用

The application of shockwave balloon in percutaneous coronary intervention for severe coronary artery calcification

目的:观察新型冲击波球囊碎石技术在冠状动脉(冠脉)严重钙化病变中的治疗效果。方法:根据冠脉造影结果以及腔内影像学指导,将25例患者分为冲击波组(15例)和对照组(10例)。其中,冲击波组12例采用光学相干断层成像(optical coherence tomography, OCT)检查,3例采用血管内超声(intravascular ultrasound, IVUS)检查;对照组6例行OCT检查,4例行IVUS检查。比较两组患者术中使用耗材情况、手术曝光时间、斑块负荷、最小管腔直径、最小管腔面积、支架内最小管腔面积及支架膨胀率,并记录术后和半年随访期间发生的主要心血管不良事件。结果:冲击波组术中使用耗材数量明显减少,曝光时间明显缩短[(120.34±7.05) min vs(80.66±6.19) min,P<0.05]。两组患者术后的斑块负荷、最小管腔直径和最小管腔面积均较术前明显改善(均P<0.05)。与对照组比较,冲击波组术后支架内最小管腔面积[(9.23±1.37) mm^(2) vs (11.89±3.25) mm^(2),P<0.05]和支架膨胀率[(78.31±3.55)%vs (89.22±2.65)%,P<0.05]改善更为明显。所有患者术后以及半年随访期间均未发生主要心血管不良事件。结论:冲击波球囊导管技术在冠脉严重钙化病变中应用是安全有效的。

Objective To evaluate the therapeutic effect of a new type of shockwave lithotripsy in the treatment of severe coronary calcification.Methods Based on the results of coronary angiography and guidance of intracavitary imaging, 25 patients were divided into the shockwave group(n=15) and control group(n=10). In the shockwave group, OCT was performed in 12 cases and IVUS in 3 cases. In the control group, OCT was performed in 6 cases and IVUS in 4 cases. The use of consumables during the operation, surgical exposure time, plaque burden, minimal lumen diameter, minimal lumen area, minimal lumen area inside the stent, and stent expansion rate were compared between the two groups. Major cardiovascular adverse events were recorded after surgery and during the 6-month follow-up.Results In the shockwave group, the amount of consumables use during operation was significantly reduced and the exposure time was significantly shortened[(120.34±7.05) min vs (80.66±6.19) min, P < 0.05]. The plaque burden, minimum lumen diameter, and minimum lumen area after surgery were significantly improved compared to those before operation in both groups(all P < 0.05). Compared with the control group, the minimum lumen area in the stent[(9.23±1.37) mm^(2)vs (11.89±3.25) mm^(2), P < 0.05] and stent expansion rate[(78.31±3.55)% vs (89.22±2.65)%, P < 0.05] improved more significantly in the shockwave group. There was no major cardiovascular adverse events occurred in all patients after surgery and during the 6-month follow-up.Conclusion It is safe and effective to apply the technique of shockwave balloon catheter in coronary artery severe calcification.