王伟民,霍勇,葛均波

• 1:北京大学人民医院
• 2:北京大学第一医院
• 3:复旦大学附属中山医院
• 4:《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》专家组

摘要(Abstract)：

尽管经皮冠状动脉介入治疗（PCI）技术不断完善进步，但冠状动脉严重钙化病变的治疗仍是挑战。通常预处理困难，术中并发症高，且术后长期预后欠佳。经皮冠状动脉腔内冲击波球囊导管成形术（IVL）作为一种新的冠状动脉钙化病变预处理技术，是利用声压力波有选择性地作用于冠状动脉内膜和中膜下的钙化病灶，在不损伤血管内膜完整性的前提下，使钙化松解并恢复血管的顺应性，引起国内医师广泛关注。然而应用中，需要规范操作，明确适应证，预防并发症的发生。因此，本文根据中国专家的临床实践和共识，遵循国家相关政策和法规，结合最新研究结果，制定专家建议，旨在引导和规范IVL技术在临床中的应用。

关键词(KeyWords)： 冲击波球囊导管成形术;冠状动脉钙化;专家建议

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 王伟民,霍勇,葛均波

参考文献(References)：

• [1]《冠状动脉钙化病变诊治中国专家共识》专家组.冠状动脉钙化病变诊治中国专家共识(2021版)[J].中国介入心脏病学杂志,2021,29(5):251-259.DOI:10.3969/j.issn.1004-8812.2021.05.002.
• [2]Honton B,Monsegu J.Best practice in intravascular lithotripsy[J].Interv Cardiol,2022,17:e02.DOI:10.15420/icr.2021.14.
• [3] 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.
• [4]Riley RF,Henry TD,Mahmud E,et al.SCAI position statement on optimal percutaneous coronary interventional therapy for complex coronary artery disease[J].Catheter Cardiovasc Interv,2020,96(2):346-362.DOI:10.1002/ccd.28994.
• [5]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:10.1161/CIRCULATIONAHA.118.036531.
• [6]Ali ZA,Nef H,Escaned J,et al.Safety and effectiveness of coronary intravascular lithotripsy for treatment of severely calcified coronary stenoses:the disrupt CADⅡstudy[J].Circ Cardiovasc Interv,2019,12(10):e008434.DOI:10.1161/CIRCINTERVENTIONS.119.008434.
• [7] 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 CAD IV study[J].Circ J,2021,85(6):826-833.DOI:10.1253/circj.CJ-20-1174.
• [8]Tian F,Zhou SS,Liu JH,et al.Treatment of severely calcified coronary artery disease by intravascular lithotripsy primary outcomes and 180-day follow-up from the Chinese SOLSTICE trial[J].J Geriatr Cardiol,2023,20(1):32-39.DOI:10.2659 9/1671-5411.2023.01.005.
• [9] Kereiakes DJ,Di Mario C,Riley RF,et al.Intravascular lithotripsy for treatment of calcified coronary lesions:patientlevel pooled analysis of the disrupt CAD studies[J].JACC Cardiovasc Interv,2021,14(12):1337-1348.DOI:10.1016/j.jcin.2021.04.015.
• [10]Salazar CH,Gonzalo N,Aksoy A,et al.Feasibility,safety,and efficacy of intravascular lithotripsy in severely calcified left main coronary stenosis[J].JACC Cardiovasc Interv,2020,13(14):1727-1729.DOI:10.1016/j.jcin.2020.04.022.
• [11] Souteyrand G,Amabile N,Mangin L,et al.Mechanisms of stent thrombosis analysed by optical coherence tomography:insights from the national PESTO French registry[J].Eur Heart J,2016,37(15):1208-1216.DOI:10.1093/eurheartj/ehv711.
• [12]Tovar Forero MN,Wilschut J,Van Mieghem NM,et al.Coronary lithoplasty:a novel treatment for stent underexpansion[J].Eur Heart J,2019,40(2):221.DOI:10.1093/eurheartj/ehy593.
• [13] Aksoy A,Salazar C,Becher MU,et al.Intravascular lithotripsy in calcified coronary lesions:a prospective,observational,multicenter registry[J].Circ Cardiovasc Interv,2019,12(11):e008154.DOI:10.1161/CIRCINTERVENTIONS.119.008154.
• [14] Wanha W,Tomaniak M,Wanczura P,et al.Intravascular lithotripsy for the treatment of stent underexpansion:the multicenter IVL-DRAGON registry[J].J Clin Med,2022,11(7):1779.DOI:10.3390/jcm11071779.
• [15]Blachutzik F,Honton B,Escaned J,et al.Safety and effectiveness of coronary intravascular lithotripsy in eccentric calcified coronary lesions:a patient-level pooled analysis from the Disrupt CADⅠand CADⅡStudies[J].Clin Res Cardiol,2021,110(2):228-236.DOI:10.1007/s00392-020-01737-3.
• [16]Kereiakes DJ,Virmani R,Hokama JY,et al.Principles of intravascular lithotripsy for calcific plaque modification[J].JACC Cardiovasc Interv,2021,14(12):1275-1292.DOI:10.1016/j.jcin.2021.03.036.
• [17]Pishchalnikov YA,Neucks JS,VonDerHaar RJ,et al.Airpockets trapped during routine coupling in dry head lithotripsy can significantly decrease the delivery of shock wave energy[J].J Urol,2006,176(6 Pt 1):2706-2710.DOI:10.1016/j.juro.2006.07.149.
• [18]Tovar Forero MN,Van Mieghem NM,Daemen J.Stent underexpansion due to heavy coronary calcification resistant to rotational atherectomy:a case for coronary lithoplasly?[J].Catheter Cardiovasc Inkerv,2020,96(3):598-600.DOI:10.1002/ccd.28641.
• [19] Jurado-Roman A,Garcia A,Moreno R.ELCA-Tripsy:combination of laser and lithotripsy for severely calcified lesions[J].J Invasive Cardiol,2021,33(9):E754-E755.
• [20]Buono A,Basavarajaiah S,Choudhury A,et al."RotaTripsy"for severe calcified coronary artery lesions:insights from a realworld multicenter cohort[J].Cardiovasc Revasc Med,2022,37:78-81.DOI:10.1016/j.carrev.2021.06.132.
• [21]Wlodarczak A,Rola P,Barycki M,et al.Rota-lithotripsy:a combination of rotational atherectomy and intravascular lithotripsy(Shockwaves)as a novel strategy for a rotablation-resistant lesion in a patient with ST-segment elevation myocardial infarction[J].Cardiol J,2021,28(6):993-994.DOI:10.5603/CJ.2021.0144.
• [22]Mintz GS,Kovach JA,Javier SP,et al.Mechanisms of lumen enlargement after excimer laser coronary angioplasty.An intravascular ultrasound study[J].Circulation,1995,92(12):3408-3414.DOI:10.1161/01.cir.92.12.3408.
• [23]吴永健.冠状动脉钙化病变预处理不同方法的选择[J].临床心血管病杂志,2022,38(7):517-520.DOI:10.13201/j.issn.1001-1439.2022.07.001.
• [24] Takahashi T,Menegus M,Choi H,et al.Complementary utility of intravascular lithotripsy with atherectomy for severely calcified coronary stenoses in contemporary practice[J].J Invasive Cardiol,2023,35(1):E46-E54.
• [25]Wong B,Kam KK,So CY,et al.Synergistic coronary artery calcium modification with combined atherectomy and intravascular lithotripsy[J].J Invasive Cardiol,2023,35(3):E128-E135.
• [26]Abdel-Wahab M,Toelg R,Byrne RA,et al.High-speed rotational atherectomy versus modified balloons prior to drug-eluting stent implantation in severely calcified coronary lesions[J].Circ Cardiovasc Interv,2018,11(10):e007415.DOI:10.1161/CIRCINTERVENTIONS.118.0074 15.
• [27] Bilodeau L,Fretz EB,Taeymans Y,et al.Novel use of a highenergy excimer laser catheter for calcfied and complex coronary artery lesions[J].Catheter Cardiovasc Interv,2004,62(2):155-161.DOI:10.1002/ccd.20053.
• [28]Dini CS,Tomberli B,Mattesini A,et al.Intravascular lithotripsy for calcific coronary and peripheral artery stenoses[J].EuroIntervention,2019,15(8):714-721.DOI:10.4244/EIJ-D-18-01056.
• [29]Ali ZA,Kereiakes D,Hill I,et al.Safety and effectiveness of coronary intravascular lithotripsy for treatment of calcified nodules[J].JACC Cardiovasc Interv,2023,16(9):1122-1124.DOI:10.1016/j.jcin.2023.02.015.
• [30]Mousa MAA,Bingen BO,Amri IA,et al.Bailout intravascular lithotripsy for the treatment of acutely underexpanded stents in heavily calcified coronary lesions:a case series[J].Cardiovasc Revasc Med,2022,40:189-194.DOI:10.1016/j.carrev.2021.12.002.
• [31]Thandra A,Betts L,Aggarwal G,et al.Intravascular lithotripsy for acute stent under-expansion and in-stent restenosis:a case series[J].Curr Probl Cardiol,2023,48(2):101511.DOI:10.1016/j.cpcardiol.2022.101511.