针对冠状动脉钙化结节的旋转式、轨道式动脉粥样硬化切除术和血管内碎石术:光学相干断层扫描的启示。

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Keisuke Yasumura, Anoop N Koshy, Manish Vinayak, Yuliya Vengrenyuk, Shingo Minatoguchi, Parasuram Krishnamoorthy, Amit Hooda, Raman Sharma, Vishal Kapur, Joseph Sweeny, Samin K Sharma, Annapoorna S Kini
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引用次数: 0

摘要

背景:冠状动脉钙化结节(CN)的最佳治疗策略仍不确定。我们旨在评估在光学相干断层扫描(OCT)引导下,不同钙化修饰策略(包括旋转动脉粥样硬化切除术(RA)、轨道动脉粥样硬化切除术(OA)和血管内碎石术(IVL))治疗冠状动脉钙化结节的有效性和安全性:纳入2017年1月至2022年12月期间在OCT引导下使用RA、OA或IVL对严重钙化病变进行经皮冠状动脉介入治疗(PCI)的连续患者。主要终点是PCI术后最小支架面积(MSA)。次要终点包括CN部位的MSA和1年靶血管失败(TVF),TVF定义为心源性死亡、靶血管心肌梗死或靶血管血运重建的综合结果:在 154 名患者和 158 个病变中,有 54 个病变(34.2%)被确定为 CN,并进行了 RA(39%,n = 21)、OA(33%,n = 18)或 IVL(28%,n = 15)处理。IVL 组的最小管腔直径、最大钙弧和最大钙厚度均较大。PCI后的OCT显示,在调整形态学因素后,MSA(RA:6.23 ± 0.34 mm²,OA:5.75 ± 0.39 mm²,IVL:6.24 ± 0.46 mm²;p = 0.62)和CN部位的MSA(分别为7.17 ± 0.43 mm²、6.46 ± 0.49 mm²、7.86 ± 0.56 mm²;p = 0.55)具有可比性。组间1年的TVF发生率相似(RA:19.0%,OA:22.2%,IVL:13.3%,P = 0.81):对于接受PCI治疗的CN患者,使用RA、OA或IVL可获得相似的手术和临床结果。这些发现值得在更大规模的前瞻性试验中进一步研究。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Rotational, orbital atherectomy and intravascular lithotripsy for coronary calcified nodules: insights from optical coherence tomography.

Background: The optimal treatment strategy for coronary calcified nodules (CN) remains uncertain. We aimed to evaluate the efficacy and safety of different calcium modification strategies, including rotational atherectomy (RA), orbital atherectomy (OA), and intravascular lithotripsy (IVL) for managing CN with optical coherence tomography (OCT) guidance.

Methods: Consecutive patients undergoing OCT-guided percutaneous coronary intervention (PCI) for severely calcified lesions using RA, OA, or IVL between January 2017 and December 2022 were included. Primary endpoint was minimum stent area (MSA) post-PCI. Secondary endpoints included MSA at CN site and 1-year target vessel failure (TVF), defined as a composite of cardiac death, target-vessel myocardial infarction, or target vessel revascularization.

Results: Among 154 patients and 158 lesions, CN was identified in 54 lesions (34.2%) and managed with RA (39%, n = 21), OA (33%, n = 18), or IVL (28%, n = 15). The IVL group exhibited a larger minimal lumen diameter, maximum calcium arc, and maximum calcium thickness. Post-PCI OCT demonstrated comparable MSA (RA: 6.23 ± 0.34 mm², OA: 5.75 ± 0.39 mm², IVL: 6.24 ± 0.46 mm²; p = 0.62) and MSA at CN site (7.17 ± 0.43 mm², 6.46 ± 0.49 mm², 7.86 ± 0.56 mm², respectively; p = 0.55) after adjusting for morphologic factors. The incidence of TVF at 1 year was similar among the group (RA: 19.0%, OA: 22.2%, IVL: 13.3%, p = 0.81).

Conclusions: In patients undergoing PCI for CN, similar procedural and clinical outcomes can be achieved using RA, OA, or IVL. These findings warrant further investigation in larger, prospective trials.

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来源期刊
CiteScore
5.40
自引率
8.70%
发文量
419
审稿时长
2 months
期刊介绍: Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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