Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, United States of America; Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, United States of America.
Cardiovasc Revasc Med. 2020 Aug;21(8):1006-1015. doi: 10.1016/j.carrev.2020.04.029. Epub 2020 Apr 29.
Intravascular lithotripsy (IVL) (Shockwave Medical, Inc., Fremont, California, USA) is a novel technology used to modify heavily calcified atherosclerotic plaque in vessels to help facilitate percutaneous coronary intervention and has been shown to be effective in treating critical lesions within the lower limbs. In addition, studies are currently underway evaluating IVL's feasibility in de novo calcified stenotic coronary arteries before stenting. The use and associated complications of IVL in other vascular territories are underreported. We report our institution's initial experience using IVL for the treatment of complex, heavily calcified lesions within the aortic arch vessels.
We treated five patients with IVL of the aortic arch vessels, including the carotid (2), subclavian (2), and innominate arteries. Four of the five patients underwent successful IVL treatment and intervention without complications. One patient (carotid intervention) developed acute right eye blindness post-procedure, thought to be due to an embolic plaque, which was successfully treated with tissue plasminogen activator and intravenous heparin.
IVL offers promising technology to facilitate the treatment of complex lesions in the vessels of the aortic arch. We do not promote the use of IVL but promote prospective clinical trials to assess the safety and efficacy of this technology in this vascular territory.
血管内碎石术（IVL）（美国加利福尼亚州弗里蒙特市 Shockwave Medical，Inc.）是一种用于修饰血管内重度钙化粥样斑块的新技术，有助于促进经皮冠状动脉介入治疗，并已被证明在治疗下肢关键病变方面有效。此外，目前正在进行研究，评估 IVL 在支架置入前治疗新出现的钙化狭窄性冠状动脉的可行性。IVL 在其他血管区域的使用情况及其相关并发症报道较少。我们报告了我们机构使用 IVL 治疗主动脉弓血管内复杂重度钙化病变的初步经验。
我们对 5 例主动脉弓血管的 IVL 治疗进行了研究，包括颈动脉（2 例）、锁骨下动脉（2 例）和无名动脉。5 例患者中有 4 例成功进行了 IVL 治疗且无并发症。1 例患者（颈动脉介入）术后出现右眼急性失明，考虑为栓塞斑块所致，经组织型纤溶酶原激活剂和静脉肝素治疗后成功治疗。
IVL 为治疗主动脉弓血管内复杂病变提供了有前途的技术。我们不提倡使用 IVL，但提倡进行前瞻性临床试验，以评估该技术在这一血管区域的安全性和有效性。
