正确方向的切片-定向动脉粥样硬化切除术治疗上肢血管功能不全及并发诊断的新应用

IF 0.1 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Animesh Singla, Y. Cai, Krishna Kotecha, T. Baillie, Daniel Nguyen
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引用次数: 0

摘要

大血管血管炎是公认的实体,影响主动脉、主动脉上支血管、颅内血管,以及不太常见的外周动脉。巨细胞动脉炎(GCA)是影响老年患者最常见的大血管血管炎之一。尽管有诊断标准,但最终诊断的支柱是颞动脉活检。最近,辅助超声已被用于在活检前识别跳过的病变。由于患者年龄和疾病复发的风险,影响分支血管的下游缺血传统上通过开放式血运重建来管理。血管内策略治疗急性或慢性血管炎的经验一直在稳步增加。我们报告了一个不寻常的急性巨细胞血管炎病例,使用血管内斑块切除装置进行诊断和治疗。患者是一名74岁的女性,既往有风湿性多肌痛病史,长期免疫抑制,新发的严重左臂跛行和休息疼痛。她接受了高级别左腋动脉病变的定向腔内斑块切除术和药物涂层血管成形术的治疗。她的血管造影结果很好。术中斑块切除标本显示存在急性GCA,这促使采用急性血管炎方案进行治疗。在3个月的随访中,她治疗段的通畅性良好,症状完全缓解。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A slice in the right direction – Novel use of directional atherectomy for treatment of upper limb vascular insufficiency and concurrent diagnosis
Large-vessel vasculitides are well-recognized entities, affecting the aorta, supra-aortic branch vessels, cranial vessels, and less commonly, peripheral arteries. Giant cell arteritis (GCA) is one of the most frequent large-vessel vasculitides affecting elderly patients. Despite diagnostic criteria, the mainstay of definitive diagnosis has been temporal artery biopsies. More recently, adjuvant ultrasound has been used to identify skip lesions before the biopsy. Downstream ischemia affecting branch vessels has traditionally been managed by open revascularization due to patient age and risk of disease recurrence. Experience with endovascular strategies for the management of acute or chronic vasculitides has been steadily increasing. We present an unusual case of acute giant cell vasculitis, diagnosed and treated with the use of an endovascular atherectomy device. The patient was a 74-year-old woman, with prior history of polymyalgia rheumatica, long-standing immunosuppression, and new onset of significant left arm claudication and rest pain. She underwent treatment for a high-grade left axillary artery lesion with directional atherectomy and drug-coated angioplasty. She had a good angiographic result. The intraoperative atherectomy specimen revealed the presence of acute GCA which prompted treatment with an acute vasculitis regimen. She had good patency of the treated segment at 3-month follow-up with complete resolution of her symptoms.
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