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)：

目的 评价经皮冠状动脉腔内冲击波球囊导管成形术（IVL）治疗冠状动脉钙化结节的效果，并观察IVL处理钙化结节后出现冠状动脉夹层的情况。方法 回顾性分析2023年3月至2024年7月于北京大学首钢医院心血管内科住院的冠状动脉粥样硬化性心脏病（冠心病）患者，冠状动脉造影检查存在中重度狭窄并伴有钙化，随后行冠状动脉血管内超声（IVUS）检查后行IVL治疗的患者共106例，按照患者冠状动脉病变是否存在钙化结节分为两组：钙化结节组39例及非钙化结节组67例，观察两组手术期间的冠状动脉夹层发生情况，并比较两组间围术期内其他相关并发症及经皮冠状动脉介入治疗（PCI）术后1个月内的主要不良心血管事件（MACE）。结果 钙化结节组在肾功能不全（25.6%比9.0%,P=0.021）及肌酐水平[（119.71±134.75）μmol/L比（71.82±16.53）μmol/L,P=0.033]方面显著高于非钙化结节组，差异均有统计学意义。钙化结节组的靶血管以左前降支和右冠状动脉为主，非钙化结节组以左前降支为主，两组左回旋支均较少，两组在左前降支和右冠状动脉的靶血管分布上差异有统计学意义（P=0.020）。两组钙化病变特点比较，差异有统计学意义（P=0.048），且钙化结节组非对称性钙化（48.7%比28.4%,P=0.035）显著高于非钙化结节组，差异有统计学意义。两组在IVL脉冲次数上比较，差异有统计学意义（P=0.022）。钙化结节组IVL过程中滑动方面（48.7%比28.4%,P=0.035）显著高于非钙化结节组，差异有统计学意义。两组介入治疗成功率均为100%；在IVL治疗后出现冠状动脉夹层，钙化结节组显著高于非钙化结节组（41.0%比17.9%,P=0.009），差异有统计学意义。两组在PCI术后1个月内的MACE发生率方面钙化结节组略高于非钙化结节组，但差异无统计学意义（P=0.235）。结论 IVL对于冠状动脉钙化结节病变的治疗是可行且有效的，但在治疗过程中，应警惕冠状动脉夹层的发生，尽早识别，及时处理。

关键词(KeyWords)： 冠状动脉钙化结节;冲击波球囊导管成形术;冠状动脉夹层;主要不良心血管事件

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 姜浩,王智,史震涛,孙敏,方士杰,唐强

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