Optical Coherence Tomography Characterization of Coronary Lithoplasty for Treatment of Calcified Lesions
Optical Coherence Tomography Characterization of Coronary Lithoplasty for Treatment of Calcified Lesions
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DOI：
10.1016/j.jcmg.2017.05.012
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发表时间：
2017-08-01
影响因子：
14
通讯作者：
Fajadet, Jean
中科院分区：
文献类型：
--
作者：
Ali, Ziad A.;Brinton, Todd J.;Fajadet, Jean
背景技术Shockwave Coronary Rx Lithoplasty System（ShockwaveMedical，Fremont，加州）在靶病变（即，方法我们分析了31例采用碎石术治疗严重钙化狭窄冠状动脉病变的患者的OCT表现。结果在碎石术后，43%的病变中发现了斑块内钙化骨折，其中25%以上发现了环周多发性骨折。在最严重钙化斑块中，每处病变的钙断裂频率增加（最高三分位数与最低三分位数; p = 0.009），钙断裂发生率有增加的趋势（77.8%与22.2%; p = 0.057）。结石成形术后，平均急性面积增加为2.1 mm（2），支架植入后进一步增加，最小支架面积为5.94 ± 1.98 mm（2），平均支架扩张为112.0 ± 37.2%。深夹层，作为血管成形术的效果的一部分，发生在13%的情况下，并成功地治疗与支架植入术没有发生急性关闭，慢流/无回流，或perforation.CONCLUSIONS高分辨率成像OCT划定钙改性骨折的主要机制，在体内的作用，并表现出在实现显着的急性面积增益和有利的支架扩张的有效性。(C)2017年美国心脏病学院基金会。
OBJECTIVES This study sought to determine the mechanistic effects of a novel balloon-based lithoplasty system on heavily calcified coronary lesions and subsequent stent placement using optical coherence tomography (OCT).BACKGROUND The Shockwave Coronary Rx Lithoplasty System (Shockwave Medical, Fremont, California) delivers localized, lithotripsy-enhanced disruption of calcium within the target lesion (i.e., lithoplasty) for vessel preparation before stent implantation.METHODS We analyzed OCT findings in 31 patients in whom lithoplasty was used to treat severely calcified stenotic coronary lesions.RESULTS After lithoplasty, intraplaque calcium fracture was identified in 43% of lesions, with circumferential multiple fractures noted in >25%. The frequency of calcium fractures per lesion increased in the most severely calcified plaques (highest tertile vs. lowest tertile; p = 0.009), with a trend toward greater incidence of calcium fracture (77.8% vs. 22.2%; p = 0.057). Post-lithoplasty, mean acute area gain was 2.1 mm(2), which further increased with stent implantation, achieving a minimal stent area of 5.94 +/- 1.98 mm(2) and mean stent expansion of 112.0 +/- 37.2%. Deep dissections, as part of the angioplasty effect, occurred in 13% of cases and were successfully treated with stent implantation without incidence of acute closure, slow flow/no reflow, or perforation.CONCLUSIONS High-resolution imaging by OCT delineated calcium modification with fracture as a major mechanism of action of lithoplasty in vivo and demonstrated efficacy in the achievement of significant acute area gain and favorable stent expansion. (C) 2017 by the American College of Cardiology Foundation.