Diaz Miguel A, Patton Marquand, Benincasa Maria, Derakhshan Daryoosh, Macedo Francisco Y
Division of Cardiology, Department of Internal Medicine, Palmetto General Hospital, Hialeah, FL, USA.
J Cardiol Cases. 2020 Feb 6;21(5):176-178. doi: 10.1016/j.jccase.2020.01.002. eCollection 2020 May.
Chronic mesenteric ischemia is an uncommon disorder in the USA. Frequently, a percutaneous approach is the first therapeutic choice to reduce its symptoms and improve outcomes. After an initial treatment with stents, further interventions might be necessary to address in-stent restenosis and re-establish a better visceral flow. Using laser atherectomy in a similar fashion as used in the peripheral arteries, has proven to be safe helping to achieve a desired final result. We present a case of chronic mesenteric ischemia in a 53-year-old man caused by severe in-stent restenosis who had abdominal pain and weight loss. We used a 0.9 mm laser catheter with low energy and pulse rate as an adjunct to balloon therapy. After revascularization, the patient's symptoms improved dramatically. To the best of our knowledge, this is the first published case in which atherectomy with laser was used to treat severe in-stent restenosis of a mesenteric vessel in chronic mesenteric ischemia. Learning Objective The treatment of severe in-stent restenosis of the superior mesenteric artery using laser atherectomy is safe and can give excellent results when traditional percutaneous therapies fail.
在美国，慢性肠系膜缺血是一种罕见的疾病。通常，经皮治疗方法是减轻其症状并改善预后的首选治疗方式。在初次使用支架治疗后，可能需要进一步干预以解决支架内再狭窄问题并重新建立更好的内脏血流。以与外周动脉相同的方式使用激光斑块切除术已被证明是安全的，有助于实现理想的最终效果。我们报告一例53岁男性慢性肠系膜缺血病例，该患者因严重的支架内再狭窄出现腹痛和体重减轻。我们使用了能量和脉冲率较低的0.9毫米激光导管作为球囊治疗的辅助手段。血运重建后，患者症状显著改善。据我们所知，这是首例发表的使用激光斑块切除术治疗慢性肠系膜缺血中肠系膜血管严重支架内再狭窄的病例。学习目标当传统经皮治疗失败时，使用激光斑块切除术治疗肠系膜上动脉严重支架内再狭窄是安全的，并且可以取得优异的效果。
