Nakano Takayuki, Ikenaga Hiroki, Takeda Atsushi, Morita Yuichi, Higashihara Tasuku, Watanabe Noriaki, Sada Yoshiharu, Nakano Yukiko
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Cardiovasc Revasc Med. 2023 Apr;49:15-21. doi: 10.1016/j.carrev.2022.12.010. Epub 2022 Dec 31.
Excimer laser coronary angioplasty (ELCA) has been reported to be a safe and effective atherectomy device in percutaneous coronary intervention (PCI). However, thrombotic complications after ELCA have been occasionally observed. In this study, we evaluated the impact of attenuated plaque on thrombus formation and transient no-reflow after ELCA.
This study enrolled 58 lesions in 56 patients who underwent PCI with ELCA. It was a retrospective observational study at a single center. All lesions were imaged by intravascular ultrasound (IVUS) before and immediately after ELCA. On the plaque with ultrasound attenuation, attenuation angle per millimeter and attenuation length were measured. ELCA-induced thrombus was detected by IVUS, and transient no-reflow after ELCA was recorded.
Thrombus was detected in 14 lesions (30 %), and transient no-reflow occurred in 3 lesions (5 %). Lesions with thrombus had a higher mean attenuation angle (median [interquartile range] 142° [112°-152°] vs. 64° [0°-115°]; p = 0.001), maximum attenuation angle (209° [174°-262°] vs. 86° [0°-173°]; p < 0.001), and longer attenuation length (12 mm [8 mm-17 mm] vs. 2 mm [0 mm-5 mm]; p < 0.001). Lesions with thrombus leading to transient no-reflow had a longer lipid length and a significantly higher troponin I level after PCI.
IVUS-identified attenuated plaque was strongly correlated with ELCA-induced thrombus. Furthermore, attenuation length may predict transient no-reflow.
准分子激光冠状动脉成形术（ELCA）在经皮冠状动脉介入治疗（PCI）中被报道是一种安全有效的斑块旋切装置。然而，ELCA术后的血栓形成并发症偶尔会被观察到。在本研究中，我们评估了衰减斑块对ELCA术后血栓形成和短暂无复流的影响。
本研究纳入了56例接受ELCA PCI治疗的患者的58个病变。这是一项在单一中心进行的回顾性观察研究。所有病变在ELCA术前和术后即刻通过血管内超声（IVUS）成像。在有超声衰减的斑块上，测量每毫米的衰减角度和衰减长度。通过IVUS检测ELCA诱导的血栓，并记录ELCA术后的短暂无复流情况。
14个病变（30%）检测到血栓，3个病变（5%）发生短暂无复流。有血栓的病变平均衰减角度更高（中位数[四分位间距]142°[112°-152°]对64°[0°-115°]；p = 0.001），最大衰减角度更高（209°[174°-262°]对86°[0°-173°]；p < 0.001），衰减长度更长（12 mm[8 mm-17 mm]对2 mm[0 mm-5 mm]；p < 0.001）。导致短暂无复流的有血栓病变脂质长度更长，PCI术后肌钙蛋白I水平显著更高。
IVUS识别的衰减斑块与ELCA诱导的血栓密切相关。此外，衰减长度可能预测短暂无复流。
