2018 年第 4 期 第 13 卷

新型准分子激光在复杂冠状动脉病变介入治疗中的应用

Application of excimer laser coronary atherectomy in complex coronary intervention

作者：刘巍周玉杰赵迎新郭永和史冬梅刘宇扬周志明成万钧葛海龙王志坚张健维王建龙刘睿芳胡宾刘晓丽

英文作者：

单位：100029首都医科大学附属北京安贞医院心内十二病房

英文单位：

关键词：复杂冠状动脉病变；准分子激光术；桡动脉；钙化；慢性完全阻塞

英文关键词：

• 摘要：

• 目的    总结准分子激光冠状动脉斑块消融术（ELCA）在冠状动脉钙化及慢性完全阻塞等复杂冠状动脉病变介入治疗中的初步应用经验。方法    回顾性分析2015年3月至2017年12月在首都医科大学附属北京安贞医院心血管病中心采用ELCA治疗的38例（44处病变）复杂冠状动脉疾病患者的临床资料。其中球囊不能通过或不能扩张的钙化病变18处，慢性完全阻塞10处，支架内再狭窄（ISR）11处，桥血管及血栓病变5处。手术即刻成功标准为术中由血管造影证实导管通过病变部位，术后靶病变残余狭窄＜50%，心肌梗死溶栓治疗血流3级，无术中并发症。临床成功标准为手术即刻成功以及术后1个月无主要不良事件发生。观察治疗效果。结果    44处病变中，5处因严重血管钙化，激光导管未能成功通过；2处因血栓负荷过重，ELCA后出现无复流；1处ISR术中发生穿孔；手术即刻成功率为81.8%（36/44）。27处（61.4%）病变成功置入药物涂层支架，12处（27.3%）病变行药物涂层球囊扩张。1例ISR患者术后出现心脏压塞，1例患者术后因心力衰竭死亡，2例择期转外科进行血运重建。结论    ELCA可作为冠状动脉介入治疗失败和复杂冠状动脉病变患者的一种选择，成功率较高，但远期疗效有待进一步随访观察。

• Objective    To analyze the experience of excimer laser coronary atherectomy（ELCA） in complex coronary intervention. Methods    Thirty-eight patients with 44 complex coronary lesions who were treated with ELCA from March 2015 to December 2017 in Beijing Anzhen Hospital, Capital Medical University were retrospectively analyzed; 18 lesions were balloon uncrossable calcified lesions; 10 lesions were chronic total occlusion; 11 lesions were in-stent restenosis(ISR); 5 lesions were saphenous vein graft lesions or thrombosis. ELCA technical success was defined as the laser catheter crossing the entire length of stenotic lesion determined by angiography, less than 50% residual stenosis and thrombolysis in myocardial infarction grade 3 after ELCA and adjunctive therapy. Clinical success was defined as procedural success with absence of major adverse events in 1 month. Results   Forty-four lesions were included; 5 severe calcified lesions were uncrossed by the ELCA catheter; 2 thrombotic lesions developed no reflow after ELCA; 1 ISR lesion was complicated with perforation during ELCA procedure. The ELCA success rate was 81.8%（36/44）. Twenty-seven(61.4%) lesions were successfully implanted drug-eluting stents; 12(27.3%) lesions were dilated with drug eluting balloons. One ISR patient developed pericardial tamponade after ELCA; 1 patient died of heart failure; 2 patients underwent elective coronary artery bypass graft surgery. Conclusion    sELCA is an alternative solution with acceptable performance in the treatment of complex coronary lesions and coronary intervention failure, with high success rate. However, the long term outcomes need further follow-up.