Recent advances in diagnosis and interventional therapy of coronary artery calcification
-
摘要: 冠状动脉钙化(CAC)在经皮冠状动脉介入治疗(PCI)患者中越来越普遍,其明显限制了PCI器械的应用及技术手段实施,导致PCI相关的主要不良心血管事件增多。本文介绍了近些年最新的CAC影像学诊断方法、PCI器械和管理策略,以期更好地改善CAC患者的临床预后。Abstract: Coronary artery calcification(CAC) is increasingly prevalent in percutaneous coronary intervention(PCI) patient population. It significantly limits the procedural success of PCI, and is associated with a higher risk of major adverse cardiovascular events both in the short-term and long-term. This review introduces the latest imaging diagnosis methods, PCI instruments and management strategies of CAC in recent years, in order to improve the clinical prognosis of patients with CAC.
-
-
表 1 腔内影像学对冠脉钙化程度的分级
Table 1. Intracavitary imaging grading of coronary calcification degree
项目 IVUS的钙化评分 OCT的钙化评分 评分标准 ①钙化长度>5 mm(钙化弧度>270°)(1分)
②360°环形钙化(1分)
③血管直径≤3.5 mm(1分)
④钙化结节(1分)①钙化弧度>180°(2分),90~180°(1分)
②钙化长度>5 mm(1分)
③横截面钙化厚度>0.5 mm(1分)轻中度钙化 0~1 0~3 重度钙化 ≥2 ≥4 -
[1] Bamford P, Collins N, Boyle A. A state-of-the-art review: the percutaneous treatment of highly calcified lesions[J]. Heart Lung Circ, 2022, 31: 1573-1584. doi: 10.1016/j.hlc.2022.08.009
[2] Angsubhakorn N, Kang N, Fearon C, et al. Contemporary management of severely calcified coronary lesions[J]. J Pers Med, 2022, 12: 1638. doi: 10.3390/jpm12101638
[3] Ban XF, Li ZY, Duan YC, et al. Advanced imaging modalities provide new insights into coronary artery calcification[J]. Eur J Radiol, 2022, 157: 110601. doi: 10.1016/j.ejrad.2022.110601
[4] Matsuhiro Y, Nakamura D, Shutta R, et al. Maximum calcium thickness is a useful predictor for acceptable stent expansion in moderate calcified lesions[J]. Int J Cardiovasc Imaging, 2020, 36: 1609-1615. doi: 10.1007/s10554-020-01874-w
[5] Torii S, Jinnouchi H, Sakamoto A, et al. Vascular responses to coronary calcification following implantation of newer-generation drug-eluting stents in humans: impact on healing[J]. Eur Heart J, 2020, 41: 786-796. doi: 10.1093/eurheartj/ehz850
[6] Lawton JS, Tamis-Holland JE, Bangalore S, et al. 2021 ACC/AHA/SCAI Guideline for Coronary Artery Revascularization: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines[J]. Circulation, 2022, 145: e18-e114. doi: 10.1161/CIRCULATIONAHA.121.057538
[7] Healy A, Berus JM, Christensen JL, et al. Statins disrupt macrophage rac1 regulation leading to increased atherosclerotic plaque calcification[J]. Arterioscler Thromb Vasc, 2020, 40: 714-732. doi: 10.1161/ATVBAHA.119.313832
[8] Secco GG, Buettner A, Parisi R, et al. Clinical experience with very high-pressure dilatation for resistant coronary lesions[J]. Cardiovasc Revasc Med, 2019, 20: 1083-1087. doi: 10.1016/j.carrev.2019.02.026
[9] 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: e007415. doi: 10.1161/CIRCINTERVENTIONS.118.007415
[10] 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: 826-833. doi: 10.1253/circj.CJ-20-1174
[11] Kenichi Sakakura, Yoshiaki Ito, Yoshisato Shibata, et al. Clinical expert consensus document on rotational atherectomy from the Japanese association of cardiovascular intervention and therapeutics: update 2023[J]. Cardiovasc Interv Ther, 2023, 38: 141-162. doi: 10.1007/s12928-022-00906-7
[12] Genereux P, Kirtane A. J, Kandzari D. E, et al. Randomized evaluation of vessel preparation with orbital atherectomy prior to drug-eluting stent implantation in severely calcified coronary artery lesions: Design and rationale of the ECLIPSE trial[J]. Am Heart J, 2022, 249: 1-11. doi: 10.1016/j.ahj.2022.03.003
[13] Karacsonyi J, Armstrong EJ, Truong HTD, et al. Contemporary use of laser during percutaneous coronary interventions: insights from the laser veterans affairs(LAVA)Multicenter Registry[J]. Invasive Cardiol, 2018, 30: 195-201.
-