{"title":"应用OCT和OFDI对冠状动脉严重钙化病变行血管内碎石术和不行动脉粥样硬化切除术的比较分析。","authors":"Marohito Nakata, Masami Abe, Toshiya Chinen, Kentaro Nakamura","doi":"10.1002/ccd.70226","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Intravascular lithotripsy (IVL) fractures calcified plaques and facilitates lesion expansion; however, unlike atherectomy devices, it does not reduce calcium volume. The therapeutic efficacy and safety of combining IVL with atherectomy remain unclear. Therefore, this study aimed to evaluate, through optical coherence tomography (OCT) or optical frequency domain imaging (OFDI), whether IVL combined with atherectomy provides greater effectiveness compared with IVL alone.</p><p><strong>Aims: </strong>This study aimed to evaluate, using optical coherence tomography (OCT) and optical frequency domain imaging (OFDI), whether intravascular lithotripsy (IVL) combined with atherectomy provides greater procedural efficacy and safety compared with IVL alone in the treatment of severely calcified coronary lesions.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 33 lesions in 31 patients who underwent IVL-based percutaneous coronary intervention (PCI) with OCT or OFDI. The primary endpoints were post-PCI minimal lumen diameter (MLD) and minimal lumen area (MLA). The secondary endpoints included calcium fracture thickness, lesion expansion rate, and vessel expansion index.</p><p><strong>Results: </strong>The mean patient age was 72.3 ± 8.5 years, and 80.6% were men. No significant differences were identified in post-PCI MLD or MLA between the IVL alone and IVL + atherectomy groups (MLD: 2.46 ± 0.38 vs. 2.23 ± 0.56 mm; MLA: 4.9 ± 1.55 vs. 4.19 ± 1.90 mm<sup>2</sup>). The secondary endpoints were also comparable. However, the combination group demonstrated a longer procedural time (82.7 ± 19.6 vs. 109.8 ± 34.0 min) and a higher incidence of periprocedural myocardial infarction (0 vs. 3 patients).</p><p><strong>Conclusions: </strong>Combination therapy resulted in a longer procedural time and an increased incidence of myocardial injury. IVL alone may be sufficient in lesions where device delivery is feasible, whereas atherectomy should be performed when IVL delivery is challenging.</p>","PeriodicalId":520583,"journal":{"name":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","volume":" ","pages":""},"PeriodicalIF":0.0000,"publicationDate":"2025-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Comparative Analysis of Intravascular Lithotripsy With and Without Atherectomy in Severely Calcified Coronary Lesions Using OCT and OFDI.\",\"authors\":\"Marohito Nakata, Masami Abe, Toshiya Chinen, Kentaro Nakamura\",\"doi\":\"10.1002/ccd.70226\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Intravascular lithotripsy (IVL) fractures calcified plaques and facilitates lesion expansion; however, unlike atherectomy devices, it does not reduce calcium volume. The therapeutic efficacy and safety of combining IVL with atherectomy remain unclear. Therefore, this study aimed to evaluate, through optical coherence tomography (OCT) or optical frequency domain imaging (OFDI), whether IVL combined with atherectomy provides greater effectiveness compared with IVL alone.</p><p><strong>Aims: </strong>This study aimed to evaluate, using optical coherence tomography (OCT) and optical frequency domain imaging (OFDI), whether intravascular lithotripsy (IVL) combined with atherectomy provides greater procedural efficacy and safety compared with IVL alone in the treatment of severely calcified coronary lesions.</p><p><strong>Methods: </strong>A retrospective analysis was performed on 33 lesions in 31 patients who underwent IVL-based percutaneous coronary intervention (PCI) with OCT or OFDI. The primary endpoints were post-PCI minimal lumen diameter (MLD) and minimal lumen area (MLA). The secondary endpoints included calcium fracture thickness, lesion expansion rate, and vessel expansion index.</p><p><strong>Results: </strong>The mean patient age was 72.3 ± 8.5 years, and 80.6% were men. No significant differences were identified in post-PCI MLD or MLA between the IVL alone and IVL + atherectomy groups (MLD: 2.46 ± 0.38 vs. 2.23 ± 0.56 mm; MLA: 4.9 ± 1.55 vs. 4.19 ± 1.90 mm<sup>2</sup>). The secondary endpoints were also comparable. However, the combination group demonstrated a longer procedural time (82.7 ± 19.6 vs. 109.8 ± 34.0 min) and a higher incidence of periprocedural myocardial infarction (0 vs. 3 patients).</p><p><strong>Conclusions: </strong>Combination therapy resulted in a longer procedural time and an increased incidence of myocardial injury. IVL alone may be sufficient in lesions where device delivery is feasible, whereas atherectomy should be performed when IVL delivery is challenging.</p>\",\"PeriodicalId\":520583,\"journal\":{\"name\":\"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2025-10-05\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1002/ccd.70226\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1002/ccd.70226","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景：血管内碎石术（IVL）可破碎钙化斑块并促进病变扩张；然而，与动脉粥样硬化切除术不同，它不会减少钙的体积。IVL联合动脉粥样硬化切除术的疗效和安全性尚不清楚。因此，本研究旨在通过光学相干断层扫描（OCT）或光学频域成像（OFDI）来评估IVL联合动脉粥样硬化切除术是否比单独IVL更有效。目的：本研究旨在通过光学相干断层扫描（OCT）和光学频域成像（OFDI）来评价血管内碎石（IVL）联合动脉粥样硬化切除术在治疗严重钙化冠状动脉病变方面是否比单独IVL具有更高的手术疗效和安全性。方法：回顾性分析31例经ivl行OCT或OFDI经皮冠状动脉介入治疗（PCI）患者的33个病变。主要终点为pci术后最小管腔直径（MLD）和最小管腔面积（MLA）。次要终点包括钙骨折厚度、病变扩张率和血管扩张指数。结果：患者平均年龄72.3±8.5岁，男性占80.6%。单纯IVL组和IVL +动脉粥样硬化切除术组pci后MLD或MLA无显著差异（MLD: 2.46±0.38 vs 2.23±0.56 mm; MLA: 4.9±1.55 vs 4.19±1.90 mm2）。次要终点也具有可比性。然而，联合组手术时间较长（82.7±19.6分钟vs 109.8±34.0分钟），术中心肌梗死发生率较高（0例vs 3例）。结论：联合治疗导致手术时间延长，心肌损伤发生率增高。在设备输送可行的病变中，仅IVL可能就足够了，而当IVL输送有困难时，应进行动脉粥样硬化切除术。
Comparative Analysis of Intravascular Lithotripsy With and Without Atherectomy in Severely Calcified Coronary Lesions Using OCT and OFDI.
Background: Intravascular lithotripsy (IVL) fractures calcified plaques and facilitates lesion expansion; however, unlike atherectomy devices, it does not reduce calcium volume. The therapeutic efficacy and safety of combining IVL with atherectomy remain unclear. Therefore, this study aimed to evaluate, through optical coherence tomography (OCT) or optical frequency domain imaging (OFDI), whether IVL combined with atherectomy provides greater effectiveness compared with IVL alone.
Aims: This study aimed to evaluate, using optical coherence tomography (OCT) and optical frequency domain imaging (OFDI), whether intravascular lithotripsy (IVL) combined with atherectomy provides greater procedural efficacy and safety compared with IVL alone in the treatment of severely calcified coronary lesions.
Methods: A retrospective analysis was performed on 33 lesions in 31 patients who underwent IVL-based percutaneous coronary intervention (PCI) with OCT or OFDI. The primary endpoints were post-PCI minimal lumen diameter (MLD) and minimal lumen area (MLA). The secondary endpoints included calcium fracture thickness, lesion expansion rate, and vessel expansion index.
Results: The mean patient age was 72.3 ± 8.5 years, and 80.6% were men. No significant differences were identified in post-PCI MLD or MLA between the IVL alone and IVL + atherectomy groups (MLD: 2.46 ± 0.38 vs. 2.23 ± 0.56 mm; MLA: 4.9 ± 1.55 vs. 4.19 ± 1.90 mm2). The secondary endpoints were also comparable. However, the combination group demonstrated a longer procedural time (82.7 ± 19.6 vs. 109.8 ± 34.0 min) and a higher incidence of periprocedural myocardial infarction (0 vs. 3 patients).
Conclusions: Combination therapy resulted in a longer procedural time and an increased incidence of myocardial injury. IVL alone may be sufficient in lesions where device delivery is feasible, whereas atherectomy should be performed when IVL delivery is challenging.
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