Department of Cardiology, Military Hospital Jaipur, Jaipur, India.
Department of Cardiology, Base Hospital Delhi Cantt, New Delhi, India.
BMJ Case Rep. 2021 Jan 25;14(1):e239143. doi: 10.1136/bcr-2020-239143.
Calcified lesions often result in undilatable lesions, balloon dog-boning, poor device delivery as well as underexpanded stents (UES). This leads to an increased risk of acute and chronic stent failure. A 49-year-old man was admitted with anterior wall myocardial infarction and angiogram showed a diffuse calcific left anterior descending artery/diagonal lesion, which was stented with two overlapping drug-eluting stents. Angiogram after post-dilatation showed UES. Optical coherence tomography (OCT) confirmed UES with 58% expansion, minimum stent area (MSA) of 2.91 mm and 360° calcium arc around the stent. This UES was dilated with a ultra high-pressure balloon (UHPB) at 40 atmosphere, that led to calcium fracture and increased MSA to 7.42 mm and stent expansion to 97%. While OCT-guided lesion modification prior to stenting is ideal, OCT-guided assessment and management is also invaluable post-percutaneous coronary intervention. In the event of stent underexpansion, UHPB may be used as an initial management strategy.
钙化病变常导致不可扩张病变、球囊狗骨化、器械输送不良以及支架未完全扩张（UES）。这会增加急性和慢性支架失败的风险。一名 49 岁男性因前壁心肌梗死入院，血管造影显示弥漫性左前降支/对角钙化病变，使用两个重叠的药物洗脱支架进行了支架置入。后扩张血管造影显示 UES。光学相干断层扫描（OCT）证实 UES 扩张率为 58%，最小支架面积（MSA）为 2.91mm，支架周围存在 360°钙弧。使用 40 个大气压的超高压力球囊（UHPB）对 UES 进行扩张，导致钙断裂，MSA 增加至 7.42mm，支架扩张至 97%。虽然在支架置入前进行 OCT 指导下的病变修饰是理想的，但 OCT 指导下的评估和管理在经皮冠状动脉介入治疗后也是非常有价值的。在支架扩张不足的情况下，可将 UHPB 作为初始治疗策略。
