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When Calcium Gets Tough, the Tough Cardiologist Starts to Play ...

机译：当钙变得艰难时，艰难的心脏病学家开始玩......

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Coronary calcification is a hard challenge for the interventional cardiologist, as it is associated with incomplete stent expansion and frequently stent failure. In recent years, innovative techniques, such as rotational atherectomy, have been developed to treat coronary calcification. However, these are burdened with an increased procedural risk. We report the case of a 60-year-old Caucasian man treated 1 month before at another center with primary coronary angioplasty and stenting of the ramus intermedius for coronary syndrome. Coronary angiography showed a critical stenosis of the left main coronary artery as well as critical calcified stenosis of the left anterior descending artery and the diagonal branch. Coronary calcification was treated with rotational atherectomy that preceded the angioplasty and stenting. Because of persistence of the symptomatology, coronary angiography was repeated 1 month later and showed a critical calcified restenosis of the ramus intermedius at the site of the previous stenting. Considering the high risk of traditional atherectomy, we performed lithotripsy-enhanced disruption of calcium beyond the stents with the Shockwave Coronary Lithoplasty System. The Shockwave Coronary Lithoplasty System has been introduced recently in order to treat calcified coronary lesions with greater safety. The procedure allows most calcified coronary lesions to be treated with simplicity and safety. This system employs sound waves, similar to those used for treating kidney stones, to crush the calcified lesions. We present the first case described to date in whom this technique was successfully used to treat calcified restenosis in a previous stent. (c) 2019 S. Karger AG, Basel
机译：冠状动脉钙化是介入心脏病学家的艰难挑战，因为它与不完全支架的扩张和经常支架失败有关。近年来，已经开发出创新的技术，例如旋转粥样切除术，以治疗冠状动脉钙化。然而，这些受到增加的程序风险的负担。我们举报了一个60岁的白种人男子在另一个中心治疗的一个60岁的白种人男子，其在另一个中心对初级冠状动脉血管成形术和用于冠状动脉综合征的Ramus中间体支架。冠状动脉造影显示左主冠状动脉的临界狭窄，以及左前期下降动脉和对角线分支的关键钙化狭窄。冠状动脉钙化被旋转粥样化切除术治疗，所述血管成形术之前并支撑。由于症状学持续存在，冠状动脉造影1个月后重复，并在先前支架的部位显示Ramus介质的关键钙化再狭窄。考虑到传统形态切除术的高风险，我们通过Shockwave冠状动图系统进行了超越支架超越支架的碎石术。最近引入了Shockwave冠状动脉膜成形术系统，以便以更大的安全处理钙化冠状病变。该程序允许以简单和安全处理最钙化的冠状动脉病变。该系统采用声波，类似于用于治疗肾结石的波浪，以粉碎钙化病变。我们介绍了该技术成功用于治疗以前支架的钙化再狭窄的第一种情况。 （c）2019年S. Karger AG，巴塞尔

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