Imaoka Takuro, Takagi Kensuke, Morita Yasuhiro, Kanzaki Yasunori, Nagai Hiroaki, Watanabe Naoki, Tsuboi Hideyuki, Morishima Itsuro
Department of Cardiology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki, Japan.
Eur Heart J Case Rep. 2020 Dec 1;4(6):1-8. doi: 10.1093/ehjcr/ytaa411. eCollection 2020 Dec.
Acute coronary syndrome caused by unprotected left main coronary artery (ACS-ULMCA) occlusion has a high mortality due to the formation of plaques and rich thrombi. Although excimer laser coronary angioplasty (ELCA) is effective in debulking and ablation of plaque burden and rich thrombi, its effectiveness in ACS-ULMCA remains unknown.
We conducted percutaneous coronary intervention (PCI) using ELCA for six patients with ACS-ULMCA from February 2016 to May 2019. This case series includes a 65-year-old man who presented with sudden-onset chest pain. Angiography revealed subtotal occlusion of the left main coronary artery (LMCA). The use of a 0.9-mm ELCA catheter advanced from LMCA to the left anterior descending artery markedly improved coronary blood flow, and intravascular ultrasound revealed debulking of the plaque and thrombus. Another 79-year-old man presented with chest pain. Angiography revealed total occlusion of LMCA. Use of a 0.9-mm ELCA catheter improved coronary blood flow. Subsequent kissing balloon technique led to satisfactory results. All cases needed mechanical support (such as intra-aortic balloon pumping or percutaneous cardiopulmonary support) prior to PCI. Five patients survived finally, and one died 34 days after primary PCI.
After stabilizing haemodynamics by mechanical support, ELCA could be a good option to improve coronary blood flow in patients with ACS-ULMCA.
无保护左主干冠状动脉闭塞所致急性冠状动脉综合征（ACS-ULMCA）因斑块形成和血栓丰富而死亡率高。尽管准分子激光冠状动脉成形术（ELCA）在减轻斑块负荷和消融丰富血栓方面有效，但其在ACS-ULMCA中的有效性尚不清楚。
2016年2月至2019年5月，我们对6例ACS-ULMCA患者使用ELCA进行了经皮冠状动脉介入治疗（PCI）。该病例系列包括一名65岁突发胸痛的男性。血管造影显示左主干冠状动脉（LMCA）次全闭塞。使用从LMCA推进至左前降支动脉的0.9毫米ELCA导管显著改善了冠状动脉血流，血管内超声显示斑块和血栓减轻。另一名79岁男性表现为胸痛。血管造影显示LMCA完全闭塞。使用0.9毫米ELCA导管改善了冠状动脉血流。随后的双球囊技术取得了满意的结果。所有病例在PCI前均需要机械支持（如主动脉内球囊反搏或经皮心肺支持）。最终5例患者存活，1例在初次PCI后34天死亡。
在通过机械支持稳定血流动力学后，ELCA可能是改善ACS-ULMCA患者冠状动脉血流的一个良好选择。
