刘巍,周玉杰,赵迎新,史冬梅,刘宇扬,周志明,郭永和,成万钧,葛海龙,王建龙,胡宾,刘晓丽

• 1:首都医科大学附属北京安贞医院心内科

摘要(Abstract)：

目的介绍准分子激光冠状动脉斑块消融术(ELCA)在钙化病变及慢性完全闭塞病变(CTO)等复杂冠状动脉病变中的应用及经验分享。方法纳入2015年3月至2016年4月首都医科大学附属北京安贞医院15例复杂冠状动脉病变患者,共15处病变行ELCA辅助治疗。观察终点为手术即刻成功和临床成功。结果 15处病变血管均应用0.9 mm导管进行消融,所有病变均成功通过激光导管,最后行球囊扩张。9例(60.0%)患者球囊不能通过病变,6例(40.0%)球囊不能扩张病变。13例(86.7%)患者置入药物洗脱支架,2例(13.3%)患者行药物球囊扩张。手术即刻成功率为100%,临床成功率为100%。平均随访(6.2±3.3)个月未见主要不良心血管事件及ELCA相关并发症发生。结论本研究所选择患者的钙化病变及CTO中,ELCA成功率较高,尚未见并发症发生,可以在复杂冠状动脉病变中进一步推广。

关键词(KeyWords)： 准分子激光冠状动脉斑块消融术;经桡动脉;复杂冠状动脉病变

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 刘巍,周玉杰,赵迎新,史冬梅,刘宇扬,周志明,郭永和,成万钧,葛海龙,王建龙,胡宾,刘晓丽

参考文献(References)：

• [1]Olivari Z,Rubartelli P,Piscione F,et al.Immediate results and one-year clinical outcome after percutaneous coronary interventions in chronic total occlusions:data from a multicenter,prospective,observational study(TOAST-GISE).J Am Coll Cardiol,2003,41(10):1672-1678.
• [2]Topaz O.Whose fault is it?Notes on“true”versus“pseudo”laser failure.Cathet Cardiovasc Diagn,1995,36(1):1-4.
• [3]Bilodeau L,Fretz EB,Taeymans Y,et al.Novel use of a highenergy excimer laser catheter for calcified and complex coronary artery lesions.Catheter Cardiovasc Interv,2004,62(2):155-161.
• [4]Badr S,Ben-Dor I,Dvir D,et al.The state of the excimer laser for coronary intervention in the drug-eluting stent era.Cardiovasc Revasc Med,2013,14(2):93-98.
• [5]王伟民,霍勇,葛均波,等.冠状动脉钙化病变诊治中国专家共识.中国介入心脏病学杂志,2014,22(22):69-73.
• [6]张慧平,孙福成.冠状动脉慢性完全闭塞病变的介入治疗现状.中国介入心脏病学杂志,2013,21(21):251-255.
• [7]Lam SC,Bertog S,Sievert H.Excimer laser in management of underexpansion of a newly deployed coronary stent.Catheter Cardiovasc Interv,2014,83(1):E64-E68.
• [8]Giugliano GR,Falcone MW,Mego D,et al.A prospective multicenter registry of laser therapy for degenerated saphenous vein graft stenosis:the COronary graft Results following Atherectomy with Laser(CORAL)trial.Cardiovasc Revasc Med,2012,13(2):84-89.
• [9]Fernandez JP,Hobson AR,Mc Kenzie D,et al.Beyond the balloon:excimer coronary laser atherectomy used alone or in combination with rotational atherectomy in the treatment of chronic total occlusions,non-crossable and non-expansible coronary lesions.Euro Intervention,2013,9(2):243-250.
• [10]Mc Kenzie DB,Talwar S,Jokhi PP,et al.How should I treat severe coronary artery calcification when it is not possible to dilate a balloon or deliver a Rota WireTM?Euro Intervention,2011,6(6):779-783.
• [11]Ambrosini V,Sorropago G,Laurenzano E,et al.Early outcome of high energy Laser(Excimer)facilitated coronary angioplasty ON h ARD and complex calcified and balloon-resistant coronary lesions:LEONARDO Study.Cardiovasc Revasc Med,2015,16(3):141-146.