Tassone Eliezer Joseph, Tripolino Cesare, Morabito Gaetano, Grillo Placido, Missiroli Bindo
Department of Cardiac Surgery, Cardiology Unit, Sant'Anna Hospital, Catanzaro, Italy,
Department of Cardiac Surgery, Cardiology Unit, Sant'Anna Hospital, Catanzaro, Italy.
Cardiology. 2018;141(3):167-171. doi: 10.1159/000495177. Epub 2019 Jan 10.
Coronary calcification is a hard challenge for the interventional cardiologist, as it is associated with incomplete stent expansion and frequently stent failure. In recent years, innovative techniques, such as rotational atherectomy, have been developed to treat coronary calcification. However, these are burdened with an increased procedural risk. We report the case of a 60-year-old Caucasian man treated 1 month before at another center with primary coronary angioplasty and stenting of the ramus intermedius for coronary syndrome. Coronary angiography showed a critical stenosis of the left main coronary artery as well as critical calcified stenosis of the left anterior descending artery and the diagonal branch. Coronary calcification was treated with rotational atherectomy that preceded the angioplasty and stenting. Because of persistence of the symptomatology, coronary angiography was repeated 1 month later and showed a critical calcified restenosis of the ramus intermedius at the site of the previous stenting. Considering the high risk of traditional atherectomy, we performed lithotripsy-enhanced disruption of calcium beyond the stents with the Shockwave Coronary Lithoplasty System. The Shockwave Coronary Lithoplasty System has been introduced recently in order to treat calcified coronary lesions with greater safety. The procedure allows most calcified coronary lesions to be treated with simplicity and safety. This system employs sound waves, similar to those used for treating kidney stones, to crush the calcified lesions. We present the first case described to date in whom this technique was successfully used to treat calcified restenosis in a previous stent.
冠状动脉钙化对介入心脏病学家来说是一项艰巨的挑战，因为它与支架扩张不完全以及频繁的支架失败有关。近年来，已经开发出了诸如旋磨术等创新技术来治疗冠状动脉钙化。然而，这些技术存在手术风险增加的问题。我们报告了一例60岁的白种男性病例，该患者1个月前在另一家中心接受了冠状动脉综合征的冠状动脉造影及中间支支架置入术。冠状动脉造影显示左主干冠状动脉严重狭窄，以及左前降支和对角支严重钙化狭窄。在血管成形术和支架置入术前，通过旋磨术治疗冠状动脉钙化。由于症状持续存在，1个月后再次进行冠状动脉造影，结果显示在先前支架置入部位的中间支出现严重钙化再狭窄。考虑到传统旋磨术的高风险，我们使用冲击波冠状动脉碎石系统对支架外的钙进行碎石增强破坏。冲击波冠状动脉碎石系统最近已被引入，以便更安全地治疗钙化性冠状动脉病变。该手术能够简单且安全地治疗大多数钙化性冠状动脉病变。该系统利用类似于治疗肾结石的声波来粉碎钙化病变。我们展示了迄今为止首例成功使用该技术治疗先前支架内钙化再狭窄的病例。
