Allen David W, Kaul Prashant
Department of Medicine, Section of Cardiology Max Rady College of Medicine, University of Manitoba, Y3543 Bergen Cardiac Care Centre St. Boniface Hospital Winnipeg, Manitoba, R2H 2A6, Canada.
Cardiac Catheterization Laboratory, Piedmont Heart Institute, 95 Collier Road, Suite 2065, Atlanta, Georgia, 30309, USA.
Curr Treat Options Cardiovasc Med. 2019 Mar 4;21(3):13. doi: 10.1007/s11936-019-0717-4.
Interventional cardiologists are increasingly being called upon to perform complex revascularization in patients who are deemed not to be candidates for surgical revascularization and, until recently, many of these patients would have only been offered medical management. Further, changing demographics have resulted in an increasingly elderly and frail population with diabetes and chronic kidney disease being referred for revascularization. Owing to the increasing prevalence of coronary artery calcification and the importance of achieving complete revascularization, advanced tools and techniques are required to safely revascularize this patient population.
Coronary artery calcification is a marker for increased periprocedural complications and worse long-term outcomes in percutaneous intervention. Its presence may mandate advanced revascularization strategies to facilitate safe revascularization. Several studies have highlighted the importance of intracoronary imaging and there have been iterative changes and new devices that have been developed that can facilitate revascularization in the setting of significant coronary artery calcification. Successful coronary revascularization is increasingly dependent on the rational use of intraavascular imaging, specialized balloons and atherectomy to overcome complex coronary artery disease and calcification. A rational strategy for the safe use of advanced techniques and tools is presented here.
介入心脏病学家越来越多地被要求对那些被认为不适合进行外科血运重建的患者进行复杂的血运重建，直到最近，许多这类患者还只能接受药物治疗。此外，人口结构的变化导致越来越多的老年体弱患者伴有糖尿病和慢性肾脏病前来接受血运重建。由于冠状动脉钙化的患病率不断上升以及实现完全血运重建的重要性，需要先进的工具和技术来安全地为这类患者进行血运重建。
冠状动脉钙化是经皮介入治疗中围手术期并发症增加和长期预后较差的一个标志。其存在可能需要先进的血运重建策略以促进安全的血运重建。多项研究强调了冠状动脉内成像的重要性，并且已经有了反复的改进以及开发出了新的设备，这些都有助于在严重冠状动脉钙化的情况下进行血运重建。成功的冠状动脉血运重建越来越依赖于合理使用血管内成像、专用球囊和旋切术来克服复杂的冠状动脉疾病和钙化。本文提出了一种安全使用先进技术和工具的合理策略。
