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首页> 美国卫生研究院文献>Cardiology Journal >Synergistic application of high-speed rotational atherectomy and intravascular lithotripsy for a severely calcified undilatable proximal left anterior descending coronary artery bifurcation lesion: Case of rotalithoplasty-facilitated DK-CRUSH
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Synergistic application of high-speed rotational atherectomy and intravascular lithotripsy for a severely calcified undilatable proximal left anterior descending coronary artery bifurcation lesion: Case of rotalithoplasty-facilitated DK-CRUSH

机译：高速旋转牙髓切除术和血管内岩石术治疗严重钙化未可拆不可透的近端左前期下降冠状动脉分叉病变的协同应用：旋转式成形术案例促进DK粉碎

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Coronary calcified plaques may affect both procedural and long-term outcomes of coronary stenting, resulting in impaired device deliverability, disruption of stent coatings, and poor stent expansion and apposition. A novel intravascular lithotripsy (IVL) method was introduced and recently tested in catheterization laboratories (ShockWave). A 62-year-old male presented with severely calcified proximal left anterior descending artery/diagonal true bifurcation stenosis (Medina 1,1,1) (Fig. 1A, B). The operator’s strategy was to perform IVL after small balloon pre-dilation (NC Emerge 2.0 × 12 mm, Boston Scientific Co.), but advancement of the ShockWave (ShockWave Medical Co.) balloon was unsuccessful due to the unfavorable location of the calcium. After several pre-dilations with non-compliant balloons (2.0 mm, 2.5 mm, and 3.0 mm; NC Emerge, Boston Scientific Co.) inflated to 20 atm, the artery was not fully opened and IVL advancement failed. At this stage, the operators decided to perform high-speed rotational atherectomy with 1.5 burr. Subsequently, due to residual large calcific plaque burden after rotablation, the IVL balloon (3.5 × 12 mm) was placed within the lesion and 80 seconds of wave was applied to modify the plaque (Fig. 1C, D). Finally, the diagonal branch was protected with the wire and regular angioplasty was performed. The well-known classic double-kissing crush technique was implemented for the patient. Operators deployed Orsiro 2.5 × 22 mm (15 atm) (Biotronik) in the diagonal branch followed by another Orsiro stent 3.5 × 22 mm (14 atm) (Biotronik) in the left anterior descending artery. The final proximal optimalization technique with 3.5 × 8 mm (16 atm) (NC Emerge; Boston Scientific Co.) was used and achieved an excellent angiographic result (Fig. 1E, F).
机译：冠状动脉钙化斑块可能影响冠状动脉抵抗的程序和长期结果，导致器件可递增性，支架涂层的破坏以及支架膨胀和环容不足。引入了一种新型血管内碎石术（IVL）方法，最近在导管插入实验室（Shockwave）进行了测试。一名62岁的男性呈现严重钙化的近端前下降动脉/对角线真肌分叉狭窄（麦地那1,1,1）（图1A，B）。运营商的策略是在小气球前扩张后进行IVL（NC出现2.0×12毫米，波士顿科学有限公司），但由于钙的不利位置，冲击波（Shockwave Medical Co.）气球的进步是不成功的。经过几种非柔顺气球的预膨胀（2.0毫米，2.5毫米和3.0毫米; NC Emerge，波士顿科学有限公司）膨胀为20个ATM，动脉未完全开放，IVL进步失败。在这个阶段，运营商决定用1.5毛刺进行高速旋转粥样孔切除术。随后，由于旋转后剩余大的钙斑块负荷，将IVL球囊（3.5×12mm）置于损伤内，施加80秒的波浪以改变斑块（图1C，D）。最后，对角分支用电线保护，并进行常规血管成形术。为患者实施了公知的经典双接接粉碎技术。在对角线分支中部署的Orsiro 2.5×22 mm（Biotronik）部署的Orsiro 2.5×22mm（Biotronik），然后是左前期下降动脉中的另一个奥西罗支架3.5×22mm（14atm）（Biotronik）。使用3.5×8毫米（16atm）（NC出现）的最终近端最优化技术，并达到了优异的血管造影结果（图1E，F）。

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