Hirano Shojiro, Funatsu Atsushi, Nakamura Shigeru, Ikeda Takanori
Division of Cardiovascular Medicine, Department of Internal Medicine, Toho University, 5-21-16 Omorinishi, Ota-ku, 143-8540, Tokyo, Japan.
Cardiovascular Center, Kyoto Katsura Hospital, Kyoto, Japan.
CVIR Endovasc. 2021 Sep 15;4(1):69. doi: 10.1186/s42155-021-00257-z.
Currently, the success rate of EVT for treating CTO of the SFA is high; however, EVT is still found to be insufficient in treating CTOs with severely calcified lesions. Even if the guidewire crosses the lesion, the calcifications may still cause difficulties during stent expansion.
A 78-year-old male had been reported to have intermittent claudication with chronic total occlusion (CTO) of the right superficial femoral artery (SFA). Angiography revealed severely calcified plaque (Angiographic calcium score: Group4a [1]) at the ostium of the SFA. Stenting posed a risk of underexpansion, causing the plaque to shift to the deep femoral artery. we decided to remove the calcified plaque using biopsy forceps. After removing the extended calcified plaque, the guidewire could cross easily, and the self-expandable stent was well dilated without causing the plaque to shift to the DFA.
Biopsy forceps may be used in some endovascular cases to remove severely calcified lesions. To ensure the safety of the patient, the physician must be adept at performing this technique before attempting it.
目前，血管腔内治疗（EVT）治疗股浅动脉慢性完全闭塞（CTO）的成功率较高；然而，在治疗伴有严重钙化病变的CTO时，EVT仍显不足。即使导丝穿过病变，钙化仍可能在支架扩张过程中造成困难。
一名78岁男性，有间歇性跛行，右股浅动脉慢性完全闭塞。血管造影显示股浅动脉开口处有严重钙化斑块（血管造影钙评分：4a组[1]）。置入支架存在扩张不足的风险，会导致斑块移位至股深动脉。我们决定使用活检钳去除钙化斑块。去除延伸的钙化斑块后，导丝能够轻松穿过，自膨胀支架充分扩张，未导致斑块移位至股深动脉。
活检钳可用于某些血管内病例以去除严重钙化病变。为确保患者安全，医生在尝试该技术之前必须熟练掌握。
