Andò Giuseppe, Vizzari Giampiero, Niccoli Giampaolo, Calabrò Paolo, Zimarino Marco, Spaccarotella Carmen, De Rosa Salvatore, Piccolo Raffaele, Gragnano Felice, Mancone Massimo, Muscoli Saverio, Romeo Francesco, Indolfi Ciro
Dipartimento di Medicina Clinica e Sperimentale, Università degli Studi, Messina.
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Roma.
G Ital Cardiol (Rome). 2021 Jun;22(6):480-489. doi: 10.1714/3612.35932.
Patients with severely calcified coronary lesions undergoing percutaneous revascularization have a substantial risk of adverse outcomes, both during the procedure and in the long term. Over the last decade, a renewed interest has been observed about devices for plaque modification and lesion preparation, new technologies have been introduced in clinical practice and well-known devices have undergone technical and procedural improvements. The available tools for intravascular imaging allow a detailed evaluation of the calcific plaques within all the layers of the vessel wall. The complementary use of all these tools is ultimately aimed at optimizing the mechanics of balloon angioplasty and the delivery and expansion of drug-eluting stents. It has been fully demonstrated that rotational atherectomy improves procedural success when treating heavily calcified lesions. Intravascular lithotripsy, techniques and materials used during complex procedures such as chronic total occlusions, increasing operators' experience, as well as new drug-eluting stents with excellent mechanical characteristics, have further contributed to the feasibility and the safety of treating most fibrotic and heavily calcified vessels. We finally propose an algorithm for evaluation and treatment of severely calcific coronary lesions to demonstrate how such percutaneous revascularization procedures are planned and performed.
接受经皮血管重建术的严重钙化冠状动脉病变患者在手术期间和长期都有发生不良后果的重大风险。在过去十年中，人们对斑块修饰和病变预处理设备重新产生了兴趣，新技术已引入临床实践，知名设备也在技术和操作上得到了改进。现有的血管内成像工具能够对血管壁各层内的钙化斑块进行详细评估。综合使用所有这些工具最终旨在优化球囊血管成形术的力学原理以及药物洗脱支架的输送和扩张。已经充分证明，旋磨术在治疗严重钙化病变时可提高手术成功率。血管内碎石术、在诸如慢性完全闭塞等复杂手术中使用的技术和材料、操作人员经验的增加，以及具有出色机械特性的新型药物洗脱支架，都进一步提高了治疗大多数纤维化和严重钙化血管的可行性和安全性。我们最终提出了一种评估和治疗严重钙化冠状动脉病变的算法，以展示此类经皮血管重建手术是如何规划和实施的。
