当代实践中的冠状动脉血管内碎石术:冠状动脉介入治疗的挑战与机遇。

IF 2.6 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS
Ankush Gupta, Abhinav Shrivastava, Jaskaran Singh Dugal, Sanya Chhikara, Rajesh Vijayvergiya, Navreet Singh, Ajit Chandrakant Mehta, Nalin Kumar Mahesh, Ajay Swamy
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引用次数: 0

摘要

钙化冠状动脉的经皮冠状动脉介入治疗(PCI)效果不佳。钙化病变修饰不良会阻碍支架输送、破坏载药聚合物、影响药物洗脱动力学并导致支架扩张不足(UES)。UES是钙化病变PCI术后急性支架血栓形成和支架内再狭窄的最常见原因。血管造影在识别和量化冠状动脉钙化方面的灵敏度较低,因此必须使用血管内成像。血管内成像,如血管内超声和光学相干断层扫描,可以准确识别和量化冠状动脉钙化,并在支架置入前指导适当的改造装置。可用于改造钙化斑块的方法包括改造球囊(切割球囊、刻痕球囊和高压球囊)、粥样体切除装置(旋转式粥样体切除术和轨道式粥样体切除术)和激光粥样体切除术。冠状动脉血管内碎石术(IVL)是钙化斑块改造工具箱中的最新成员。它产生的声波冲击波与冠状动脉钙质相互作用,造成多平面断裂。这些钙质断裂增加了血管的顺应性,使支架面积达到理想的最小值。冠状动脉 IVL 在一系列 Disrupt CAD 试验中证实了其对钙化病变的安全性和有效性。与动脉粥样硬化切除装置相比,它的优点包括:易于在工作母线上使用、能够改变深层钙化、无碎片栓塞导致血流缓慢或无血流以及热损伤最小。它在改造钙化结节、钙化左主干分叉病变和慢性全闭塞等疑难钙化病变亚群方面显示出良好的效果。在这篇综述中,作者将总结 IVL 的作用机制、它在当代实践中的作用、使用 IVL 的证据、它与动脉粥样硬化切除设备相比的优势,以及它在不同钙化病变情况下的成像效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Coronary intravascular lithotripsy in contemporary practice: challenges and opportunities in coronary intervention.

Percutaneous coronary intervention (PCI) of calcified coronary arteries is associated with poor outcomes. Poorly modified calcified lesion hinders the stent delivery, disrupts drug-carrying polymer, impairs drug elution kinetics and results in under-expanded stent (UES). UES is the most common cause of acute stent thrombosis and in-stent restenosis after PCI of calcified lesions. Angiography has poor sensitivity for recognition and quantification of coronary calcium, thereby mandating the use of intravascular imaging. Intravascular imaging, like intravascular ultrasound and optical coherence tomography, has the potential to accurately identify and quantify the coronary calcium and to guide appropriate modification device before stent placement. Available options for the modification of calcified plaque include modified balloons (cutting balloon, scoring balloon and high-pressure balloon), atherectomy devices (rotational atherectomy and orbital atherectomy) and laser atherectomy. Coronary intravascular lithotripsy (IVL) is the newest addition to the tool box for calcified plaque modification. It produces the acoustic shockwaves, which interact with the coronary calcium to cause multiplanar fractures. These calcium fractures increase the vessel compliance and result in desirable minimum stent areas. Coronary IVL has established its safety and efficacy for calcified lesion in series of Disrupt CAD trials. Its advantages over atherectomy devices include ease of use on workhorse wire, ability to modify deep calcium, no debris embolization causing slow flow or no-flow and minimal thermal injury. It is showing promising results in modification of difficult calcified lesion subsets such as calcified nodule, calcified left main bifurcation lesions and chronic total occlusion. In this review, authors will summarize the mechanism of action for IVL, its role in contemporary practice, evidence available for its use, its advantages over atherectomy devices and its imaging insight in different calcified lesion scenarios.

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来源期刊
Therapeutic Advances in Cardiovascular Disease
Therapeutic Advances in Cardiovascular Disease CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.50
自引率
0.00%
发文量
11
审稿时长
9 weeks
期刊介绍: The journal is aimed at clinicians and researchers from the cardiovascular disease field and will be a forum for all views and reviews relating to this discipline.Topics covered will include: ·arteriosclerosis ·cardiomyopathies ·coronary artery disease ·diabetes ·heart failure ·hypertension ·metabolic syndrome ·obesity ·peripheral arterial disease ·stroke ·arrhythmias ·genetics
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