血管内碎石术改善冠状动脉顺应性：钙化冠状动脉病变支架扩张的新预测指标

Journal of the Society for Cardiovascular Angiography & Interventions Pub Date : 2025-05-01 DOI:10.1016/j.jscai.2025.102635

Federico Oliveri MD , Martijn J.H. Van Oort MSc , Ibtihal Al Amri MD, PhD , Brian O. Bingen MD, PhD , Bimmer E. Claessen MD, PhD , Aukelien C. Dimitriu-Leen MD, PhD , Joelle Kefer MD, PhD , Hany Girgis MD , Tessel Vossenberg MD , Frank Van der Kley MD, PhD , J. Wouter Jukema MD, PhD , Josè M. Montero-Cabezas MD, PhD

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引用次数: 0

摘要

背景：血管碎石术（IVL）已被证明可以通过诱导钙骨折和促进支架扩张（SE）来有效治疗球囊可穿过的钙化冠状动脉病变，理论上是通过改善冠状动脉顺应性（CACom）。这一理论的直接证据尚未得到证实。方法从BENELUX-IVL前瞻性登记（NCT06577038）中，选择超声引导下接受IVL治疗的钙化冠状动脉病变患者。CACom是通过使用血管内超声测量的管腔面积的收缩期-舒张期变化（ΔA）相对于相应的主动脉压变化（ΔP）来计算的。在IVL治疗前（cacom前）和IVL治疗后（cacom后）在最钙化段直接测量，IVL脉冲给予。主要终点是CACom修饰（ΔCACom），定义为CACom后-CACom前，ΔCACom与新骨折之间的相关性分析是主要的探索目标。二次分析包括评估ΔCACom是否可以预测最小支架面积SE （MSA）和偏心指数。结果IVL治疗后冠状动脉顺应性明显改善(中位数ΔCACom 0.33 [0.19-0.70] mm2/mm Hg；P & lt;. 01)。出现新钙性骨折的病变与没有出现新钙性骨折的病变相比，ΔCACom显著增加。ΔCACom与新发钙质骨折显著相关(R = 0.466；P & lt;. 01)。在单变量分析中，ΔCACom被发现是MSA SE的显著预测因子(P <；.01), MSA （P = 0.015）和SE >；80% (P = 0.025)，但偏心率指数（P = 0.157）没有变化。在多变量分析中，ΔCACom是SE的独立预测因子(R = 0.420；P = 0.044)， MSA时SE >；80% (OR, 6.58 [1.24-34.90]；P = .043)。结论对于重度钙化冠状动脉病变，ΔCACom是SE的独立预测因子。

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Coronary Compliance Modification by Intravascular Lithotripsy: New Predictor of Stent Expansion in Calcified Coronary Lesions

Background

Intravascular lithotripsy (IVL) has been demonstrated to be effective in treating balloon-crossable calcified coronary lesions by inducing calcium fractures and facilitating stent expansion (SE), theoretically by improving coronary artery compliance (CACom). Direct evidence of this theory has not yet been provided.

Methods

From the BENELUX-IVL prospective registry (NCT06577038) enrolling patients with calcified coronary artery lesions treated with IVL, intravascular ultrasound–guided cases were selected. CACom was calculated as the systo-diastolic change in the luminal area (ΔA), measured using intravascular ultrasound, relative to the corresponding change in aortic pressure (ΔP). Measurements were taken directly before (pre-CACom) and after (post-CACom) IVL therapy at the most calcified segment, where IVL pulses were administered. The primary end point was CACom modification (ΔCACom), defined as post-CACom – pre-CACom, with a correlation analysis between ΔCACom and new fractures as a key exploratory aim. Secondary analysis included assessing whether ΔCACom could predict SE at the minimum stent area (MSA) and the eccentricity index.

Results

Coronary artery compliance significantly improved after IVL therapy (median ΔCACom 0.33 [0.19-0.70] mm²/mm Hg; P < .01). Lesions showing new calcium fractures presented significantly greater ΔCACom compared to those without. ΔCACom and new calcium fractures were significantly correlated (R = 0.466; P < .01). In univariate analysis, ΔCACom was found to be a significant predictor for SE at MSA (P < .01), MSA (P = .015), and SE >80% (P = .025), but not eccentricity index (P = .157). At multivariate analysis, ΔCACom was an independent predictor of SE (R = 0.420; P = .044) and SE >80% at MSA (OR, 6.58 [1.24-34.90]; P = .043).