Fiorilli Paul N, Anwaruddin Saif
Section of Interventional Cardiology, Cardiovascular Medicine Division, Hospital of the University of Pennsylvania, Philadelphia, PA, USA.
Division of Cardiovascular Medicine, Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania, South Pavilion, Floor 11-106, 3400 Civic Center Boulevard, Philadelphia, PA, 19104, USA.
Curr Treat Options Cardiovasc Med. 2016 Dec;18(12):72. doi: 10.1007/s11936-016-0498-y.
Despite significant advances in treatment of coronary artery disease and improvements in interventional devices and techniques, the subset of obstructive calcified coronary artery disease remains challenging to treat. Percutaneous treatment of these lesions results in increased rates of procedural complications, as well as a higher risk of stent underexpansion and malapposition. This is associated with higher rates of restenosis, target lesion revascularization (TLR), and major adverse cardiac events (MACE). Several interventional strategies and technologies have been developed to improve lesion preparation and successful stent implantation. This includes use of cutting and scoring balloons and atherectomy devices. Several intravascular imaging techniques have also shown to have value in the treatment of complex calcified coronary lesions. These advances have improved the treatment of patients with calcified coronary disease who are often difficult to treat and frequently excluded from large randomized trials. Thoughtful, and not routine, use of rotational atherectomy can be helpful in pre-treating severely calcified lesions to achieve successful stent delivery. Orbital atherectomy represents a newer advancement in the atherectomy approach that may be beneficial in the treatment of calcified coronary disease, but further trials are needed to support its routine use.
尽管在冠状动脉疾病的治疗方面取得了重大进展，介入设备和技术也有所改进，但阻塞性钙化冠状动脉疾病的治疗仍然具有挑战性。对这些病变进行经皮治疗会导致手术并发症发生率增加，以及支架扩张不足和贴壁不良的风险更高。这与再狭窄、靶病变血管重建（TLR）和主要不良心脏事件（MACE）的发生率较高有关。已经开发了几种介入策略和技术来改善病变预处理和成功植入支架。这包括使用切割球囊和刻痕球囊以及旋切装置。几种血管内成像技术在复杂钙化冠状动脉病变的治疗中也显示出价值。这些进展改善了钙化冠状动脉疾病患者的治疗，这类患者通常难以治疗，并且经常被排除在大型随机试验之外。谨慎而非常规地使用旋磨术有助于预处理严重钙化病变以成功输送支架。轨道旋切术是旋切术方法中的一项新进展，可能对钙化冠状动脉疾病的治疗有益，但需要进一步的试验来支持其常规使用。
