姜浩,王智,史震涛,孙敏,方士杰,唐强

• 1:北京大学首钢医院心血管内科

摘要(Abstract)：

冠状动脉左主干（LM）病变本身就是介入治疗的挑战之一，如果病变合并钙化，介入手术操作难度大且风险极高。本病例报道1例77岁老年男性患者，冠状动脉造影（CAG）提示LM-左前降支（LAD）重度狭窄伴重度钙化性分叉病变，给予预扩张后应用经皮冠状动脉腔内冲击波球囊导管成形术（IVL）治疗，IVL前针对LM-LAD病变予合适的球囊以固定压力、逐步升级球囊扩张时间的方式对病变进行缺血预适应，后行Cross-over术式置入单支架1枚，获得满意效果。其中对于LM病变进行的缺血预适应方法可以为临床医师提供借鉴。

关键词(KeyWords)： 冠状动脉钙化病变;无保护左主干病变;冲击波球囊导管成形术;缺血预适应

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 姜浩,王智,史震涛,孙敏,方士杰,唐强

参考文献(References)：

• [1]Ramadan R,Boden WE,Kinlay S.Management of left main coronary artery disease[J].J Am Heart Assoc,2018,7(7):e008151.DOI:10.1161/JAHA.117.008151.
• [2]Makikallio T,Holm NR,Lindsay M,et al.Percutaneous coronary angioplasty versus coronary artery bypass grafting in treatment of unprotected left main stenosis(NOBLE):a prospective,randomised,open-label,non-inferiority trial[J].Lancet,2016,388(10061):2743-2752.DOI:10.1016/S0140-6736(16)32052-9.
• [3]Stone GW,Sabik JF,Serruys PW,et al.Everolimus-eluting stents or bypass surgery for left main coronary artery disease[J].N Engl J Med,2016,375(23):2223-2235.DOI:10.1056/NEJMoa1610227.
• [4]Neumann F J,Sousa-Uva M,Ahlsson A,et al.2018 ESC/EACTS guidelines on myocardial revascularization[J].EuroIntervention,2019,14(14):1435-1534.DOI:10.4244/EIJY19M01 01.
• [5]Rola P,Kulczycki JJ,Barycki M,et al.Comparison of orbital atherectomy and rotational atherectomy in calcified left main disease:short-term outcomes[J].J Clin Med,2023,12(12):4025.DOI:10.3390/jcm12124025.
• [6]Brinton TJ,Ali ZA,Hill JM,et al.Feasibility of shockwave coronary intravascular lithotripsy for the treatment of calcified coronary stenoses[J].Circulation,2019,139(6):834-836.DOI:10.116 1/CIRCULATIONAHA.118.036531.
• [7]Ali ZA,Nef H,Escaned J,et al.Safety and effectiveness of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses:the Disrupt CAD II study[J].Circ Cardiovasc Interv,2019,12(10):e008434.DOI:10.1161/CIRCINTERVENTIONS.119.008434.
• [8]Hill JM,Kereiakes DJ,Shlofmitz RA,et al.Intravascular lithotripsy for treatment of severely calcified coronary artery disease[J].J Am Coll Cardiol,2020,76(22):2635-2646.DOI:10.1016/j.jacc.2020.09.603.
• [9]Saito S,Yamazaki S,Takahashi A,et al.Intravascular lithotripsy for vessel preparation in severely calcified coronary arteries prior to stent placement-primary outcomes from the Japanese Disrupt CADⅣstudy[J].Circ J,2021,85(6):826-833.DOI:10.1253/circj.CJ-20-1174.
• [10]Wong B,El-Jack S,Khan A,et al.Treatment of heavily calcified unprotected left main disease with lithotripsy:the first case series[J].J Invasive Cardiol,2019,31(6):E143-E147.
• [11]刘丰齐,鲍骏,李拜红,等.经皮冠状动脉腔内冲击波球囊导管成形术在血管内超声指导下对左主干重度钙化治疗的有效性和安全性分析[J].中国介入心脏病学杂志,2024,32(7):383-389.DOI:10.3969/j.issn.1004-8812.2024.07.003.
• [12]Lv H,Li X,Ren Z,et al.Extension of interval between adjacent pulse delivery cycles to deal with myocardial ischemia by intravascular lithotripsy:case report[J].J Cardiothorac Surg,2024,19(1):277.DOI:10.1186/s13019-024-02782-z.
• [13]王伟民,霍勇,葛均波,等.经皮冠状动脉腔内冲击波球囊导管成形术临床应用中国专家建议[J].中国介入心脏病学杂志,2023,31(9):641-649.DOI:10.3969/j.issn.1004-8812.2023.09.001.