Royal Prince Alfred Hospital, Sydney, Australia.
University of Sydney, Sydney, Australia.
Curr Cardiol Rep. 2021 Mar 5;23(4):33. doi: 10.1007/s11886-021-01458-7.
Moderate or severe calcification is present in approximately one third of coronary lesions in patients with stable ischemic heart disease and acute coronary syndromes and portends unfavorable procedural results and long-term outcomes. In this review, we provide an overview on the state-of-the-art in evaluation and treatment of calcified coronary lesions.
Intravascular imaging (intravascular ultrasound or optical coherence tomography) can guide percutaneous coronary intervention of severely calcified lesions. New technologies such as orbital atherectomy and intravascular lithotripsy have significantly expanded the range of available techniques to effectively modify coronary calcium and facilitate stent expansion. Calcium fracture improves lesion compliance and is essential to optimize stent implantation. Intravascular imaging allows for detailed assessment of patterns and severity of coronary calcium that are integrated into scoring systems to predict stent expansion, identifying which lesions require atherectomy for lesion modification. Guided by intravascular imaging, older technologies such as rotational atherectomy and excimer laser can be incorporated with newer technologies such as orbital atherectomy and intravascular lithotripsy into an algorithmic approach for the safe and effective treatment of patients with heavily calcified coronary lesions.
稳定型缺血性心脏病和急性冠脉综合征患者约有三分之一的冠状动脉病变存在中度或重度钙化，预示着手术结果不佳和长期预后不良。在这篇综述中，我们概述了评估和治疗钙化性冠状动脉病变的最新技术。
血管内影像学（血管内超声或光学相干断层扫描）可指导重度钙化病变的经皮冠状动脉介入治疗。新的技术，如旋磨术和血管内碎石术，极大地扩展了可用技术的范围，以有效地修饰冠状动脉钙并促进支架扩张。钙断裂可改善病变顺应性，是优化支架植入的关键。血管内影像学可对冠状动脉钙的形态和严重程度进行详细评估，并将其整合到评分系统中，以预测支架扩张，确定哪些病变需要旋磨术进行病变修饰。在血管内影像学的指导下，将旋磨术和准分子激光等旧技术与旋磨术和血管内碎石术等新技术结合到算法中，可安全有效地治疗重度钙化的冠状动脉病变患者。
