经桡动脉入径行准分子激光冠状动脉斑块消融术在冠状动脉钙化病变及慢性完全闭塞病变中的应用：中国最初应用经验分享

摘要

Objective Excimer laser coronary atherecomy ( ELCA) has been recently used for the treatment of complex coronary lesions including calcified stenosis , chronic total occlusions and in-stent restenosis. Such complex lesions are difficult to adequately treat with balloon angioplasty and /or intracoronary stenting.The aim of this study was to introduce our early experiences in using ELCA in China . Methods Fifteen patients were enrolled through our center from March 2015 to April 2016 , and excimer laser coronary angioplasty was performed on 15 lesions.Eleven patients were previously failed cases either from uncrossable balloon ( 9 lesions ) or expandable balloon ( 6 lesions ) . The procedure and clinical endpoints were recorded .Results Laser catheter with 0.9 mm diameters were used in all 15 coronary lesions.All the lesions were successfully crossed with laser catheter and finally dilated with balloon .The procedural success rate was 100%.Drug eluting stents ( DES ) were implanted in 86.7% lesions and 2 cases were treated with drug eluting balloon .Clinical success was obtained in all patients (100%).There was no dissection , major side branch occlusion , spasm, no-reflow phenomenon nor acute vessel closure . Conclusions This study shows that laser-facilitated coronary angioplasty is a simple , safe and effective device for the management of complex coronary lesions .%目的：介绍准分子激光冠状动脉斑块消融术（ ELCA ）在钙化病变及慢性完全闭塞病变（ CTO）等复杂冠状动脉病变中的应用及经验分享。方法纳入2015年3月至2016年4月首都医科大学附属北京安贞医院15例复杂冠状动脉病变患者，共15处病变行ELCA辅助治疗。观察终点为手术即刻成功和临床成功。结果15处病变血管均应用0．9 mm导管进行消融，所有病变均成功通过激光导管，最后行球囊扩张。9例（60．0％）患者球囊不能通过病变，6例（40．0％）球囊不能扩张病变。13例（86．7％）患者置入药物洗脱支架，2例（13．3％）患者行药物球囊扩张。手术即刻成功率为100％，临床成功率为100％。平均随访（6．2±3．3）个月未见主要不良心血管事件及ELCA相关并发症发生。结论本研究所选择患者的钙化病变及CTO中，ELCA成功率较高，尚未见并发症发生，可以在复杂冠状动脉病变中进一步推广。