Imai Yoshihiro, Yamashita Takehiro, Topaz On
Department of Cardiology, Hokkaido Ohno Memorial Hospital, Sapporo, Hokkaido, Japan Duke University School of Medicine, Durham, NC, USA.
Medicine (Baltimore). 2017 Oct;96(42):e8328. doi: 10.1097/MD.0000000000008328.
Thin-cap fibroatheroma (TCFA) and red thrombus are suggested as a high-risk of embolic complications during percutaneous coronary intervention (PCI). Intracoronary aspiration procedures occasionally result in either an insufficient thrombus removal or provide no significant effects on TCFA.
A 76-year-old male underwent coronary angiography for chest pain.
Coronary angiography revealed a tight stenosis at the right coronary artery which resulted in treatment by PCI. Optical frequency domain imaging (OFDI) delineated a red thrombus with TCFA.
To avoid embolic complications, excimer laser coronary angioplasty (ELCA) was applied with intracoronary aspiration before drug-eluting stent (DES) implantation.
The red thrombus was vaporized by ELCA in an energy-intensity dependent manner and subsequently removed by intracoronary aspiration. The fibrous cap of TCFA was dissected with the material beneath the cap ablated by ELCA and extensively removed by intracoronary aspiration. DES implantation and postdilatation achieved an optimal result without flow compromise. This combined synergistic strategy of ELCA-aspiration-DES yielded a successful outcome.
A synergistic embolus removal strategy combining ELCA, aspiration and DES implantation is a promising option for the treatment of high-risk plaque with potential embolic complications.
薄帽纤维粥样瘤（TCFA）和红色血栓被认为是经皮冠状动脉介入治疗（PCI）期间发生栓塞并发症的高危因素。冠状动脉内抽吸术偶尔会导致血栓清除不充分，或者对TCFA没有显著效果。
一名76岁男性因胸痛接受冠状动脉造影。
冠状动脉造影显示右冠状动脉严重狭窄，需行PCI治疗。光学频域成像（OFDI）显示有红色血栓伴TCFA。
为避免栓塞并发症，在植入药物洗脱支架（DES）前，先进行准分子激光冠状动脉成形术（ELCA）并结合冠状动脉内抽吸术。
ELCA以能量强度依赖的方式汽化红色血栓，随后通过冠状动脉内抽吸术将其清除。TCFA的纤维帽被切开，帽下物质被ELCA消融，并通过冠状动脉内抽吸术广泛清除。DES植入和后扩张取得了最佳效果，未出现血流受限。这种ELCA-抽吸-DES联合协同策略取得了成功。
ELCA、抽吸和DES植入相结合的协同栓子清除策略是治疗具有潜在栓塞并发症的高危斑块的一种有前景的选择。
