Raxwal Tejas, Balhara Cauvery, Parekh Dipak
Access Health Care Physicians, Hudson, Florida, USA.
Regional Medical Center Bayonet Point, Hudson, Florida, USA.
Case Rep Cardiol. 2022 Jul 15;2022:7075933. doi: 10.1155/2022/7075933. eCollection 2022.
Can intravascular lithotripsy safely modify calcium in an underexpanded stent and result in optimal expansion and improved outcome? Coronary artery calcification results in difficulty with stent delivery and expansion and is associated with adverse outcomes. Intravascular lithotripsy (IVL) by delivering acoustic pressure waves modifies calcium plaque that improve vessel compliance resulting in optimizing stent deployment.
A 63-year-old patient presented with acute coronary syndrome with symptoms of unstable angina who underwent angiography that showed calcified right coronary artery which was treated with balloon angioplasty and stenting with drug eluting stent. However, after multiple inflations with noncompliant balloon, the patient was noted to have persistent residual in stent stenosis of 70%. Stenotic lesion in poorly expanded stent was treated with Shockwave C2 Coronary Intravascular Lithotripsy catheter resulting in 0% residual stenosis. The patient was followed for major adverse cardiovascular events at 30 days and 12 months. The patient remained MACE free at 30 days and 12 months.
Coronary IVL safely and effectively facilitated stent expansion in severely calcified lesion in a poorly expanded stent with MACE free at 12-month follow-up.
血管内碎石术能否安全地改变未充分扩张支架内的钙，从而实现最佳扩张并改善预后？冠状动脉钙化会导致支架输送和扩张困难，并与不良预后相关。通过施加声压波进行的血管内碎石术（IVL）可改变钙斑块，改善血管顺应性，从而优化支架置入。
一名63岁的患者因急性冠状动脉综合征伴不稳定型心绞痛症状就诊，接受血管造影显示右冠状动脉钙化，接受了球囊血管成形术和药物洗脱支架置入术。然而，在使用非顺应性球囊多次扩张后，发现患者支架内仍有70%的持续性残余狭窄。对扩张不良的支架内狭窄病变使用冲击波C2冠状动脉血管内碎石术导管进行治疗，残余狭窄率降至0%。对该患者进行了30天和12个月的主要不良心血管事件随访。患者在30天和12个月时均未发生主要不良心血管事件。
冠状动脉IVL安全有效地促进了严重钙化病变且扩张不良的支架的扩张，在12个月的随访中未发生主要不良心血管事件。
