Division of Cardiology, Sant'Eugenio Hospital, Rome, Italy.
Catheter Cardiovasc Interv. 2019 Sep 1;94(3):395-398. doi: 10.1002/ccd.28296. Epub 2019 Apr 19.
Despite technological evolution, percutaneous coronary interventions targeting coronary calcifications remain challenging and associated with high rates of complications and adverse outcomes. Over the years, rotational atherectomy has emerged as the reference treatment of calcified coronary artery lesions despite some inherent limitations. Also, rotational atherectomy typically requires relatively large guiding catheters which may unfavorably impact on the decision for transradial access, especially when radial artery is small, and consequently offset the relevant clinical benefits associated to transradial access. Recently, a new technology has been introduced in interventional practice to implement coronary lithotripsy. The device implements multiple small emitters enclosed in a coronary balloon creating sonic pressure waves to selectively fracture calcium within the plaque and favorably modify vessel compliance. Owing to its specific design, coronary shockwave lithotripsy could be used with small bore guiding catheters which may allow for straightforward transradial percutaneous treatment of calcified coronary lesions even in patients with a small radial artery. To illustrate this concept, we report the first experience of slender transradial coronary shockwave lithotripsy with a five French sheathless guiding catheter.
尽管技术不断发展，但针对冠状动脉钙化的经皮冠状动脉介入治疗仍然具有挑战性，并且与高并发症发生率和不良预后相关。多年来，旋磨术已成为治疗钙化性冠状动脉病变的参考治疗方法，尽管存在一些固有局限性。此外，旋磨术通常需要相对较大的引导导管，这可能不利于经桡动脉入路的决策，特别是当桡动脉较小时，从而抵消了经桡动脉入路相关的临床获益。最近，一种新的技术已被引入介入治疗实践中，以实施冠状动脉碎石术。该设备采用多个小型发射器，封装在冠状动脉球囊内，产生声压波，选择性地使斑块内的钙破裂，并有利地改善血管顺应性。由于其特殊的设计，冠状动脉冲击波碎石术可以与小口径引导导管一起使用，即使在桡动脉较小的患者中，也可以方便地经桡动脉进行钙化性冠状动脉病变的经皮治疗。为了说明这一概念，我们报告了首例使用 5 French 无鞘引导导管进行的纤细经桡动脉冠状动脉冲击波碎石术的经验。
