Cleveland Clinic, 9500 Euclid Avenue, Desk J2-3, Cleveland, OH 44195. Email:
J Invasive Cardiol. 2021 May;33(5):E393-E395. doi: 10.25270/jic/20.00691. Epub 2021 Mar 15.
In recent years, there has been strong evidence to support the regular use of intravascular ultrasound (IVUS) imaging to optimize the results of percutaneous coronary intervention (PCI). This holds particularly true in more complex cases, such as calcific lesions, whereby angiographic evaluation is often insufficient to determine whether a vessel has been adequately prepared or to perform reference vessel sizing. Severe calcific lesions are often treated with coronary atherectomy to debulk the calcific plaque and allow for adequate predilation of the lesion before stenting. As we have become more familiar with the use of IVUS for stent optimization, we postulated whether certain vessel characteristics seen on IVUS could help to anticipate procedural complications. We provide a descriptive analysis, including IVUS findings, of 10 patients who underwent PCI complicated by coronary perforation following coronary atherectomy. Our findings generate the hypothesis that independent mobility of calcium identified on IVUS in patients treated with coronary atherectomy may be a warning sign for impending perforation. Further studies are needed to validate this hypothesis and to potentially identify other IVUS findings that could be associated with increased risk of procedural complications.
近年来，有强有力的证据支持常规使用血管内超声 (IVUS) 成像来优化经皮冠状动脉介入治疗 (PCI) 的结果。在更复杂的情况下，如钙化病变，血管造影评估通常不足以确定血管是否得到充分准备或进行参考血管大小测量，这一点尤其正确。严重的钙化病变通常采用冠状动脉旋磨术来减轻钙化斑块的负荷，并在支架置入前充分预扩张病变。随着我们越来越熟悉使用 IVUS 进行支架优化，我们推测 IVUS 上看到的某些血管特征是否有助于预测手术并发症。我们提供了 10 名患者的描述性分析，这些患者在冠状动脉旋磨术后行 PCI 时发生冠状动脉穿孔。我们的发现提出了一个假设，即接受冠状动脉旋磨术治疗的患者在 IVUS 上独立可移动的钙可能是即将穿孔的警告信号。需要进一步的研究来验证这一假设，并有可能确定其他可能与手术并发症风险增加相关的 IVUS 发现。
