Department of Cardiology, Higashi Takarazuka Satoh Hospital, Takarazuka, Japan.
Circ J. 2013;77(6):1445-52. doi: 10.1253/circj.cj-12-1064. Epub 2013 Mar 26.
Mechanical reperfusion has proven to be an unquestionably superior treatment strategy over that of thrombolytic therapy in patients with acute coronary syndrome (ACS). Excimer laser coronary angioplasty (ELCA) is a unique revascularization device that has a lytic effect on thrombus, in addition to its debulking effect on the atherosclerotic plaque beneath the thrombus.
This single-center retrospective analysis consisted of consecutive ACS patients treated with ELCA (n=50) and age- and sex-matched ACS patients treated with manual aspiration (n=48) without use of a distal protection device. Success rate was judged by lesion crossability, procedure complications, and significant reduction of stenosis. Tissue-level perfusion was assessed on antegrade Thrombolysis In Myocardial Infarction (TIMI) flow grade, myocardial blush grade (MBG), and ST-segment elevation resolution (STR). Short-term outcome was evaluated according to occurrence of in-hospital major adverse cardiac events (MACE; myocardial infarction, target lesion revascularization, coronary artery bypass graft, and death). Lesion crossability was higher in the ELCA group than in the aspiration group (96.2% vs. 82.6%, P=0.04). Attainment of TIMI 3 flow (86.0% vs. 68.8%, P=0.04) and MBG 3 (76.0% vs. 54.2%, P=0.02) was also higher in the ELCA group than in the aspiration group. Complete STR was similar between the 2 groups. In-hospital MACE were significantly more frequent in the aspiration group.
ELCA is feasible, safe, and effective for the treatment of patients with ACS and appears to be useful as an adjunctive lesion preparation device.
机械再灌注已被证明是治疗急性冠脉综合征（ACS）患者的一种绝对优于溶栓治疗的策略。准分子激光冠状动脉血管成形术（ELCA）是一种独特的血管重建装置，除了对血栓下的粥样斑块进行减容作用外，还具有溶栓作用。
这项单中心回顾性分析包括连续接受 ELCA 治疗的 ACS 患者（n=50）和接受无远端保护装置的手动抽吸治疗的年龄和性别匹配的 ACS 患者（n=48）。成功率通过病变可通过性、手术并发症和狭窄程度的显著降低来判断。组织水平灌注通过前向溶栓治疗心肌梗死（TIMI）血流分级、心肌染色分级（MBG）和 ST 段抬高缓解（STR）来评估。根据住院期间主要不良心脏事件（MACE；心肌梗死、靶病变血运重建、冠状动脉旁路移植术和死亡）评估短期结果。ELCA 组的病变可通过性高于抽吸组（96.2% vs. 82.6%，P=0.04）。ELCA 组达到 TIMI 3 级血流（86.0% vs. 68.8%，P=0.04）和 MBG 3 级（76.0% vs. 54.2%，P=0.02）的比例也高于抽吸组。两组的完全 STR 相似。抽吸组住院期间 MACE 的发生率明显更高。
ELCA 治疗 ACS 患者是可行、安全且有效的，并且似乎可用作辅助病变准备装置。
