Murata Nobuhiro, Takayama Tadateru, Hiro Takafumi, Hirayama Atsushi
Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan.
Catheter Cardiovasc Interv. 2018 Jun;91(7):1287-1290. doi: 10.1002/ccd.27405. Epub 2017 Nov 13.
Percutaneous coronary intervention (PCI) for patients with in-stent restenosis (ISR) is generally considered safe and effective. However, due to increased tissue hardness, PCI for calcified intra-stent ISR is technically challenging. Here, we report severe angioplasty-related complications in a patient presenting with calcified, recurrent ISR following PCI. After receiving drug-coated balloon (DCB) angioplasty for an initial ISR, the patient developed recurrent ISR during the follow-up period. Intravascular imaging revealed intra-stent calcifications and balloon angioplasty was subsequently performed. During the angioplasty, a pin-hole balloon rupture occurred, consequently causing coronary dissection as visualized by intravascular imaging. To prevent acute coronary occlusion, stent implantation was required. The present case report suggests that, following detection of intra-stent calcified stenosis, both careful balloon inflation as well as optimal ablation device selection are required to prevent potential complications and obtain successful procedural outcomes.
对于支架内再狭窄（ISR）患者，经皮冠状动脉介入治疗（PCI）通常被认为是安全有效的。然而，由于组织硬度增加，针对钙化性支架内ISR的PCI在技术上具有挑战性。在此，我们报告了1例PCI术后出现钙化性复发性ISR患者发生的严重血管成形术相关并发症。在首次ISR接受药物涂层球囊（DCB）血管成形术后，该患者在随访期间出现复发性ISR。血管内成像显示支架内钙化，随后进行了球囊血管成形术。在血管成形术期间，发生了针孔样球囊破裂，结果导致血管内成像显示的冠状动脉夹层。为防止急性冠状动脉闭塞，需要植入支架。本病例报告提示，在检测到支架内钙化狭窄后，需要谨慎球囊充盈以及选择最佳消融装置，以预防潜在并发症并获得成功的手术结果。
