准分子激光冠脉消融术在复杂冠状动脉病变介入治疗中的应用22例临床分析
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摘要
目的介绍准分子激光冠脉消融术(ELCA)在急性ST段抬高型心肌梗死(STEMI)、大隐静脉桥血管病变、钙化病变、慢性完全闭塞病变(CTO)和支架内再狭窄(ISR)等复杂冠脉病变中的应用和经验分享。方法纳入2016年11月至2017年5月北方战区总医院22例复杂冠脉病变的患者共22处病变行准分子激光冠脉消融术(ELCA)。观察终点为手术即刻成功率和临床成功率。结果 22处病变均成功通过激光导管并进行消融,5例(22.7%)急诊STEMI患者,10例(45.5%)大隐静脉桥血管病变,5例(22.7%)支架内再狭窄病变,1例(4.5%)慢性完全闭塞病变和1例(4.5%)钙化病变。17例患者最终行球囊扩张并成功植入药物洗脱支架(DES),1例患者行药物球囊扩张。手术即刻成功率为100%,临床成功率100%。平均随访(6.6±2.7)个月无主要不良心血管事件(MACE)事件及ELCA相关并发症发生。结论 ELCA应用复杂的冠脉病变具有较高的即刻成功率和临床成功率,未见ELCA相关并发症发生,可以在复杂冠脉疾病中进一步推广。
Objective The aim of this study was to introduce the experience in treatment of acute ST segment elevation myocardial infarction(STEMI), saphenous vein graft(SVG), Chronic total occlusion(CTO),In-stent restenosis(ISR)and diffuse calcification lesions by excimer laser coronary atherectomy(ELCA). Methods Twenty-two patients were enrolled through our center from November 2016 to May 2017 and ELCA was performed on 22 lesions.The clinical and procedure endpoints were recorded. Results All the lesions were successfully crossed with laser catheterand and finally were performed by ELCA. Five cases(22.7%)with STEMI, ten cases(45.5%) with SVG lesions,five cases with ISR and other cases were CTO(4.5%) and Calcification(4.5%) lesions.Seventeen patients underwent balloon dilatation and successful implantation of drug-eluting stents(DES) and one patients was treated with drug-eluting balloon(DEB).the procedual and clinical success rates were 100%. At 6.6±2.7 months follow-up, there were no major adverse cardiac events(MACEs) and ELCA relatedcomplications recorded. Conclution This limited evdiences showed that treatment of complex coronary lesions by excimer laser coronary atherectomy may be a Safe and effective choice.It can be further popularized in complex coronary artery disease.
Objective The aim of this study was to introduce the experience in treatment of acute ST segment elevation myocardial infarction(STEMI), saphenous vein graft(SVG), Chronic total occlusion(CTO),In-stent restenosis(ISR)and diffuse calcification lesions by excimer laser coronary atherectomy(ELCA). Methods Twenty-two patients were enrolled through our center from November 2016 to May 2017 and ELCA was performed on 22 lesions.The clinical and procedure endpoints were recorded. Results All the lesions were successfully crossed with laser catheterand and finally were performed by ELCA. Five cases(22.7%)with STEMI, ten cases(45.5%) with SVG lesions,five cases with ISR and other cases were CTO(4.5%) and Calcification(4.5%) lesions.Seventeen patients underwent balloon dilatation and successful implantation of drug-eluting stents(DES) and one patients was treated with drug-eluting balloon(DEB).the procedual and clinical success rates were 100%. At 6.6±2.7 months follow-up, there were no major adverse cardiac events(MACEs) and ELCA relatedcomplications recorded. Conclution This limited evdiences showed that treatment of complex coronary lesions by excimer laser coronary atherectomy may be a Safe and effective choice.It can be further popularized in complex coronary artery disease.
引文
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[6]Kubo T,Imanishi T,Kitabata H,et al.Comparison of vascular response after sirolimus-eluting stent implantation between patients with unstable and stable angina pectoris:a serial optical coherence tomography study[J].JACC Cardiovasc Imaging,2008,1(4):475-484.
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[8]于一,赵迎新,史冬梅,等.准分子激光在经桡动脉复杂冠状动脉病变介入治疗中的应用[J].中国介入心脏病学杂志,2016,24(10):587-591.
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[10]于一,赵迎新,史冬梅,等.准分子激光在经桡动脉复杂冠状动脉病变介入治疗中的应用[J].中国介入心脏病学杂志,2016,24(10):587-591.
[11]张宇晨,赵林,陈方.ST段抬高型心肌梗死经皮冠状动脉介入治疗预后的影响因素分析[J].中国实用内科杂志,2012,32(11):859-861.
[12]Shishikura D,Otsuji S,Takiuchi S,et al.Vaporizing thrombus with excimer laser before coronary stenting improves myocardial reperfusion in acute coronary syndrome[J].Circ J,2013,77(6):1445-1452.
[13]Topaz O,Ebersole D,Das T,et al.Excimer laser angioplasty in acute myocardial infarction(the CARMEL multicenter trial)[J].Am JCardiol,2004,93(6):694-701.
[14]Giugliano GR,Falcone MW,Mego D,et al.A prospective multicenter registry of laser therapy for degenerated saphenous vein graft stenosis:the COronary graft Results following Atherectomy with Laser(CORAL)trial[J].Cardiovasc Revasc Med,2012,13(2):84-89.
[15]Quan VH,Huynh R,Seifert PA,et al.Morphometric analysis of particulate debris extracted by four different embolic protection devices from coronary arteries,aortocoronary saphenous vein conduits,and carotid arteries[J].Am J Cardiol,2005,95(12):1415-1419.
[16]Fernandez JP,Hobson AR,McKenzie D,et al.Beyond the balloon:excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions,non-crossable and non-expansible coronary lesions[J].EuroIntervention,2013,9(2):243-250.
[17]刘巍,周玉杰,赵迎新,等.经桡动脉入径行准分子激光冠状动脉斑块消融术在冠状动脉钙化病变及慢性完全闭塞病变中的应用:中国最初应用经验分享[J].中国介入心脏病学杂志,2016,24(9):511-514.
[18]Dahm JB.Excimer laser coronary angioplasty(ELCA)for diffuse instent restenosis:beneficial long-term results after sufficient debulking with a lesion-specific approach using various laser catheters[J].Lasers Med Sci,2001,16(2):84-89.
[2]Fracassi F,Roberto M,Niccoli G.Current interventional coronary applications of excimer laser[J].Expert Rev Med Devices,2013,10(4):541-549.
[3]王伟民,霍勇,葛均波.冠状动脉钙化病变诊治中国专家共识[J].中国介入心脏病学杂志,2014,22(2):69-73.
[4]Topol EJ,Yadav JS.Recognition of the importance of embolization in atherosclerotic vascular disease[J].Circulation,2000,101(5):570-580.
[5]Brennan JM,Al-Hejily W,Dai D,et al.Three-year outcomes associated with embolic protection in saphenous vein graft intervention:results in49 325 senior patients in the Medicare-linked National Cardiovascular Data Registry CathPCI Registry[J].Circ Cardiovasc Interv,2015,8(3):e001403.
[6]Kubo T,Imanishi T,Kitabata H,et al.Comparison of vascular response after sirolimus-eluting stent implantation between patients with unstable and stable angina pectoris:a serial optical coherence tomography study[J].JACC Cardiovasc Imaging,2008,1(4):475-484.
[7]Jia H,Abtahian F,Aguirre AD,et al.In vivo diagnosis of plaque erosion and calcified nodule in patients with acute coronary syndrome by intravascular optical coherence tomography[J].J Am Coll Cardiol,2013,62(19):1748-1758.
[8]于一,赵迎新,史冬梅,等.准分子激光在经桡动脉复杂冠状动脉病变介入治疗中的应用[J].中国介入心脏病学杂志,2016,24(10):587-591.
[9]K?ster R,K?hler J,Brockhoff C,et al.Laser coronary angioplasty:history,present and future[J].Am J Cardiovasc Drugs,2002,2(3):197-207.
[10]于一,赵迎新,史冬梅,等.准分子激光在经桡动脉复杂冠状动脉病变介入治疗中的应用[J].中国介入心脏病学杂志,2016,24(10):587-591.
[11]张宇晨,赵林,陈方.ST段抬高型心肌梗死经皮冠状动脉介入治疗预后的影响因素分析[J].中国实用内科杂志,2012,32(11):859-861.
[12]Shishikura D,Otsuji S,Takiuchi S,et al.Vaporizing thrombus with excimer laser before coronary stenting improves myocardial reperfusion in acute coronary syndrome[J].Circ J,2013,77(6):1445-1452.
[13]Topaz O,Ebersole D,Das T,et al.Excimer laser angioplasty in acute myocardial infarction(the CARMEL multicenter trial)[J].Am JCardiol,2004,93(6):694-701.
[14]Giugliano GR,Falcone MW,Mego D,et al.A prospective multicenter registry of laser therapy for degenerated saphenous vein graft stenosis:the COronary graft Results following Atherectomy with Laser(CORAL)trial[J].Cardiovasc Revasc Med,2012,13(2):84-89.
[15]Quan VH,Huynh R,Seifert PA,et al.Morphometric analysis of particulate debris extracted by four different embolic protection devices from coronary arteries,aortocoronary saphenous vein conduits,and carotid arteries[J].Am J Cardiol,2005,95(12):1415-1419.
[16]Fernandez JP,Hobson AR,McKenzie D,et al.Beyond the balloon:excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions,non-crossable and non-expansible coronary lesions[J].EuroIntervention,2013,9(2):243-250.
[17]刘巍,周玉杰,赵迎新,等.经桡动脉入径行准分子激光冠状动脉斑块消融术在冠状动脉钙化病变及慢性完全闭塞病变中的应用:中国最初应用经验分享[J].中国介入心脏病学杂志,2016,24(9):511-514.
[18]Dahm JB.Excimer laser coronary angioplasty(ELCA)for diffuse instent restenosis:beneficial long-term results after sufficient debulking with a lesion-specific approach using various laser catheters[J].Lasers Med Sci,2001,16(2):84-89.