李姮,李永辉,何峰,温尚煜

• 1:天津市第四中心医院心血管内科天津医科大学第四中心临床学院

摘要(Abstract)：

冠状动脉钙化病变是经皮冠状动脉介入治疗（PCI）的重要挑战，常导致支架膨胀不良，进而增加支架内血栓形成与支架内再狭窄的风险。目前对钙化病变所致支架膨胀不良的处理尚缺乏统一指南或共识。国外有个案报道采用超高压非顺应性球囊处理该情况。本病例报道1例左前降支严重钙化病变患者，首次PCI经棘突球囊预处理后置入支架，后扩张球囊高压扩张后仍出现支架膨胀不良。择期予以超高压球囊进行超高压力后扩张，最终获得满意的支架膨胀与管腔面积，且无并发症发生。对于钙化病变引起的支架膨胀不良，超高压球囊可作为一种安全且有效的补救性治疗手段。

关键词(KeyWords)： 冠状动脉钙化;支架膨胀不良;超高压球囊;经皮冠状动脉介入治疗

Abstract:

Keywords:

基金项目(Foundation): 天津市教委科研计划项目（2024KJ241）

作者(Author): 李姮,李永辉,何峰,温尚煜

参考文献(References)：

• [1]Jinnouchi H,Sakakura K,Taniguchi Y,et al.Clinical outcomes and unique restenosis of calcified nodule in heavily calcified coronary artery[J].Atheroscler Thromb,2023,30(6):649-662.DOI:10.5551/jat.63667.
• [2]Matsuhiro Y,Nakamura D,Dohi T,et al.Impact of calcified nodule on target lesion failure after stent implantation in hemodialysis patients[J].Catheter Cardiovasc Interv,2023,101(4):701-712.DOI:10.1002/ccd.30599.
• [3]Ali ZA,Spratt JC,Finn AV,et al.Identification and treatment of calcified nodules in percutaneous coronary intervention[J].EuroIntervention,2025,21(23):e1424-e1433.DOI:10.4244/EIJ-D-25-00296.
• [4]Kassimis G,Raina T,Kontogiannis N,et al.How should we treat heavily calcified coronary artery disease in contemporarypractice?From atherectomy to intravascular lithotripsy[J].Cardiovasc Revasc Med,2019,20(12):1172-1183.DOI:10.1016/j.carrev.2019.01.010.
• [5]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.
• [6]吴章英,朱丽,李苏,等,经皮冠状动脉腔内冲击波球囊导管成形术和冠状动脉斑块旋磨术对冠状动脉钙化处理的安全性分析[J].中国介入心脏病学杂志,2025,33(11):634-639,DOI:10.3969/j.issn.1004-8812.2025.11.005.
• [7]Tovar Forero MN,Sardella G,Salvi N,et al.Coronary lithotripsy for the treatment of underexpanded stents:the international&multicentre CRUNCH registry[J].Euro Interv e ntion,2022,18(7):574-581.DOI:10.4244/EIJ-D-21-00545.
• [8]Urban P,Gershlick AH,Guagliumi G,et al.Safety of coronary sirolimus-eluting stents in daily clinical practice:one-year followup of the e-Cypher registry[J].Circulation,2006,113(11):1434-1441.DOI:10.1161/CIRCULATIONAHA.104.5 32242.
• [9]Kumar S,Jalli S,Sandoval Y,et al.Systematic review and meta-analysis of the super high-pressure balloon(SIS-OPN)fo r percutaneous coro nary intervention[J].Catheter Cardiovasc Interv,2025,105(4):93 8-950.DOI:10.1002/ccd.31403.
• [10]Seiler T,Attinger-Toller A,Cioffi GM,et al.Treatment of in-stent restenosis using a dedicated super high-pressure balloon[J].Cardiovasc Revasc Med,2023,46:29-35.DOI:10.1016/j.carrev.2022.08.018.
• [11] Kumaraguruparan LD,Polareddy DR,Kovvuri HR,et al.Safety and efficacy of super-high pressure OPN balloon in patients with instent restenosis-an intra-coronary imaging-based observational study[J].Sci Rep,2025,15(1):36653.DOI:10.1038/s41598-025-20488-7.
• [12]Secco GG,Ghione M,Mattesini A,et al.Very high-pressure dilatation for undilatable coronary lesions:indications and results with a new dedicated balloon[J].Euro Intervention,2016,12(3):3 59-365.DOI:10.4244/EIJY15M06 04.
• [13]Rheude T,Rai H,Richardt G,et al.Super high-pressure balloon versus scoring balloon to prepare severely calcified coronary lesions:the ISAR-CALC randomised trial[J].EuroInterventio n,2021,17(6):481-488.DOI:10.4244/EIJ-D-20-01000.
• [14]Connolly MS,Hall AB.'P re-crack the plaque technique'using OPN super high-pressure balloons in tight,calcified stenoses:a case series[J].Cardiovascular Revascularization Medicine:Interesting Cases,2025,10:Article 100114.DOI:10.1016/j.crmic.2025.100114.
• [15]Cioffi GM,Vercelli L,Avdijaj D,et al.Rotational atherectomy combined with super high-pressure noncompliant balloon in severe or recurrent in-stent restenosis[J].J Interv Cardiol,2025,2025(1).DOI:10.1155/joic/8869530.
• [16]Secco GG,Buettner A,Parisi R,et al.Clinical experience with very high-pressure dilatation for resistant coronary lesions[J].Cardiovasc Revasc Med,2019,20(12):1083-1087.DOI:10.1016/j.carrev.2019.02.026.