刘丰齐,鲍骏,李拜红,陈翀昊,高长征,过云峰,顾鑫,顾建斌,王晓彦

• 1:江南大学附属医院心内科
• 2:惠山区第二人民医院心内科

摘要(Abstract)：

目的 探讨经皮冠状动脉腔内冲击波球囊导管成形术或称血管内碎石术（IVL在血管内超声（IVUS）指导下治疗左主干（LM）重度钙化病变的有效性和安全性。方法 纳入2022年10月至2024年4月期间江南大学附属医院收治的26例LM（口部、体部、分叉）重度钙化患者，年龄72.0(61.8,75.4)岁。在IVUS指导下应用IVL对钙化病变进行预处理，再行经皮冠状动脉介入治疗（PCI）置入支架/药物球囊。所有患者均在应用IVL前后、PCI术后使用IVUS进行评估，并比较治疗前后IVUS腔内相关数据[斑块负荷（PB）、最小管腔面积（MLA）、最小管腔直径（MLD）]以及钙化断裂数、最小支架面积（MSA）、支架膨胀系数（EXP）等。结果 26例患者（2例开口病变、7例体部病变、17例主干末端分叉病变）中稳定型心绞痛（SAP）7例，不稳定型心绞痛（UA）10例，急性ST段抬高型心肌梗死（STEMI）4例和非ST段抬高型心肌梗死（NSTEMI）5例。钙化最严重部位处PB在IVL后减小[79.50(76.00,83.75)%比80.00(76.00,83.75)%,P=0.001],MLA在IVL后增大[3.39(3.14,3.68)mm~2比3.38(3.14,3.67)mm~2,P=0.039],MLD在IVL后增大[3.21(3.07,3.30)mm比3.20(3.07,3.30)mm,P=0.024],100%有钙化环断裂（2例1个，9例2个，15例≥3个），100%成功置入支架/药物球囊，EXP高达（89.15±4.42）%,MSA 7.20(6.46,7.45)mm2。术后随访3个月均无心绞痛、复发性心肌梗死和死亡等不良事件发生。结论 LM重度钙化病变经IVUS评估经IVL预处理后成功完成PCI术，IVL可作为LM重度钙化治疗的选择。

关键词(KeyWords)： 血管内碎石术;左主干;冠状动脉钙化;血管内超声

Abstract:

Keywords:

基金项目(Foundation): 江苏省卫生健康委项目（ZDA2020023）;; 无锡市卫生健康委项目（J202103）;; 无锡市科技发展资金项目（N20202019）;; 无锡市科技局医疗产业联合研究项目（5332207ZKJS）

作者(Author): 刘丰齐,鲍骏,李拜红,陈翀昊,高长征,过云峰,顾鑫,顾建斌,王晓彦

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