Si Daoyuan, Liu Guohui, Tong Yaliang, He Yuquan
Department of Cardiology, China-Japan Union Hospital of Jilin University, Jilin Provincial Engineering Laboratory for Endothelial Function and Genetic Diagnosis of Cardiovascular Disease, Jilin Provincial Cardiovascular Research Institute, Changchun, Jilin, China.
Medicine (Baltimore). 2018 Feb;97(7):e9978. doi: 10.1097/MD.0000000000009978.
Inadequate stent expansion due to rigid calcified may result in restenosis lesions, but the available options are limited.
We report a case via the trans-radial approach of the severely underexpanded freshly deployed stent due to heavily calcified plaques DIAGNOSES:: Coronary angiography revealed that there was no adequate expansion of the freshly deployed stent.
Under the guide of intravascular ultrasound (IVUS), rotational atherectomy (RA) successfully ablated the stent layers and the protruding calcified plaque. Followed by balloon angioplasty, the ablated segment was scaffolded with another stent, well expanded and documented by IVUS.
The patient was uneventful during the procedure and remained angina free at the point of one year of clinical follow-up.
This case indicated that RA via the trans-radial approach could be a useful remedy in the situation of under-expansion of implanted stents, and the debulking should be performed under IVUS-guidance.
由于僵硬的钙化病变导致支架扩张不足可能会导致再狭窄，但现有的选择有限。
我们报告了一例经桡动脉途径的病例，由于严重钙化斑块，新植入的支架严重扩张不足。
冠状动脉造影显示新植入的支架没有充分扩张。
在血管内超声（IVUS）引导下，旋磨术（RA）成功消融了支架层和突出的钙化斑块。随后进行球囊血管成形术，消融段用另一枚支架支撑，扩张良好并经IVUS记录。
患者手术过程顺利，临床随访一年时仍无心绞痛。
该病例表明，经桡动脉途径的旋磨术在植入支架扩张不足的情况下可能是一种有用的补救方法，且减容操作应在IVUS引导下进行。
