The application of shockwave balloon in percutaneous coronary intervention for severe coronary artery calcification
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摘要: 目的 观察新型冲击波球囊碎石技术在冠状动脉(冠脉)严重钙化病变中的治疗效果。方法 根据冠脉造影结果以及腔内影像学指导，将25例患者分为冲击波组(15例)和对照组(10例)。其中，冲击波组12例采用光学相干断层成像(optical coherence tomography，OCT)检查，3例采用血管内超声(intravascular ultrasound，IVUS)检查；对照组6例行OCT检查，4例行IVUS检查。比较两组患者术中使用耗材情况、手术曝光时间、斑块负荷、最小管腔直径、最小管腔面积、支架内最小管腔面积及支架膨胀率，并记录术后和半年随访期间发生的主要心血管不良事件。结果 冲击波组术中使用耗材数量明显减少，曝光时间明显缩短[(120.34±7.05) min vs(80.66±6.19) min，P < 0.05]。两组患者术后的斑块负荷、最小管腔直径和最小管腔面积均较术前明显改善(均P < 0.05)。与对照组比较，冲击波组术后支架内最小管腔面积[(9.23±1.37) mm2 vs (11.89±3.25) mm2，P < 0.05]和支架膨胀率[(78.31±3.55)% vs (89.22±2.65)%，P < 0.05]改善更为明显。所有患者术后以及半年随访期间均未发生主要心血管不良事件。结论 冲击波球囊导管技术在冠脉严重钙化病变中应用是安全有效的。Abstract: Objective To evaluate the therapeutic effect of a new type of shockwave lithotripsy in the treatment of severe coronary calcification.Methods Based on the results of coronary angiography and guidance of intracavitary imaging, 25 patients were divided into the shockwave group(n=15) and control group(n=10). In the shockwave group, OCT was performed in 12 cases and IVUS in 3 cases. In the control group, OCT was performed in 6 cases and IVUS in 4 cases. The use of consumables during the operation, surgical exposure time, plaque burden, minimal lumen diameter, minimal lumen area, minimal lumen area inside the stent, and stent expansion rate were compared between the two groups. Major cardiovascular adverse events were recorded after surgery and during the 6-month follow-up.Results In the shockwave group, the amount of consumables use during operation was significantly reduced and the exposure time was significantly shortened[(120.34±7.05) min vs (80.66±6.19) min, P < 0.05]. The plaque burden, minimum lumen diameter, and minimum lumen area after surgery were significantly improved compared to those before operation in both groups(all P < 0.05). Compared with the control group, the minimum lumen area in the stent[(9.23±1.37) mm2vs (11.89±3.25) mm2, P < 0.05] and stent expansion rate[(78.31±3.55)% vs (89.22±2.65)%, P < 0.05] improved more significantly in the shockwave group. There was no major cardiovascular adverse events occurred in all patients after surgery and during the 6-month follow-up.Conclusion It is safe and effective to apply the technique of shockwave balloon catheter in coronary artery severe calcification.
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Key words:
- coronary calcification /
- shockwave balloon /
- endoluminal imaging
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图 1 冠脉造影及PCI术后同步OCT影像
Figure 1. Coronary angiography and synchronous OCT imaging after PCI
表 1 患者一般基线资料
Table 1. General data
例(%), X ± S 项目 对照组(10例) 冲击波组(15例) P 年龄/岁 70.21±6.23 68.67±8.44 0.589 性别 男 6(60.00) 8(53.33) 0.123 女 4(40.00) 7(46.67) 0.323 BMI/(kg/m2) 23.87±5.05 24.95±4.71 0.751 吸烟史 5(50.00) 7(46.67) 0.037 糖尿病 4(40.00) 7(46.67) 0.784 高血压 7(70.00) 10(66.67) 0.322 脑卒中 3(30.00) 6(40.00) 0.303 甲状腺异常 2(20.00) 3(20.00) 0.512 高胆固醇血症 8(80.00) 9(60.00) 0.401 高同型半胱氨酸血症 3(30.00) 4(26.67) 0.551 高尿酸血症 2(20.00) 3(20.00) 0.654 家族史 5(50.00) 7(46.67) 0.425 
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表 2 冠脉钙化病变腔内影像学积分评估
Table 2. Evaluation of intracavitary imaging score in coronary calcification lesions
例(%) 项目 对照组(10例) 冲击波组(15例) χ2 P IVUS参数 1.730 0.052 Ⅰ级(≤90°) 0 0 Ⅱ级(91°~180°) 0 0 Ⅲ级(181°~270°) 3(30.00) 2(13.33) Ⅳ级(≥271°) 1(10.00) 1(6.67) OCT钙化积分 3.440 0.074 3分 2(20.00) 5(33.33) 4分 4(40.00) 7(46.67)
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表 3 PCI术中耗材应用及曝光时间比较
Table 3. Application of consumables and exposure time in PCI
例(%), X ± S 项目 对照组(10例) 冲击波组(15例) χ2/t P 半顺应性球囊 10(100.00) 7(46.67) 8.607 0.062 非顺应性球囊 9(90.00) 0 冲击波球囊 0 15(100.00) 切割球囊 4(40.00) 0 棘突球囊 6(60.00) 0 双导丝 4(40.00) 0 Guidezilla延长导管 6(60.00) 1(6.67) 3.410 < 0.010 曝光时间/min 120.34±7.05 80.66±6.19 6.054 0.019 RA 2(20.00) 0
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表 4 腔内影像学观察指标
Table 4. Indexes of intracavitary imaging
X ± S 项目 对照组(10例) 冲击波组(15例) t P 处理前 处理后 处理前 处理后 钙化斑块长度/mm 33.81±12.58 26.88±12.54 2.131 0.416 斑块负荷/% 87.66±10.71 40.21±6.011) 89.41±9.21 31.33±9.211)2) 0.281 < 0.001 最小管腔直径/mm 2.11±1.72 3.03±1.531) 1.69±1.04 3.43±2.611)2) 1.071 0.023 最小管腔面积/mm2 3.41±1.05 7.22±2.341) 2.25±1.67 9.28±4.131)2) 0.165 < 0.001 术后支架内最小管腔面积/mm2 9.23±1.37 11.89±3.252) 1.872 0.031 术后支架膨胀率/% 78.31±3.55 89.22±2.652) 0.542 < 0.001 与同组处理前比较，1)P < 0.05；与对照组处理后比较，2)P < 0.05。
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