Kawamura Akito, Egami Yasuyuki, Nishino Masami, Tanouchi Jun
Division of Cardiology, Osaka Rosai Hospital, 1179-3 Nagasone-cho, Sakai 591-8025, Japan.
Eur Heart J Case Rep. 2023 Feb 14;7(3):ytad075. doi: 10.1093/ehjcr/ytad075. eCollection 2023 Mar.
Coronary artery rupture is a rare but fatal complication of percutaneous coronary intervention (PCI). The mortality rate reaches 19% in patients with the Ellis type III classification. The predictors of coronary artery rupture were reported in previous studies. However, there are few reports showing the risk factors of this threatening complication in terms of intravascular image such as optical coherence tomography and intravascular ultrasound (IVUS).
We report the case of three patients with coronary artery rupture, who underwent IVUS-guided PCI for severe calcified lesions. All three patients developed the Ellis grade III rupture, which was successfully managed with the use of a perfusion balloon and covered stents. In these patients, the common characteristics were observed in pre-procedural IVUS images. Specifically, a -type lcified and residual hin plaque sign () was seen in all three patients.
These patient cases provide an insight into the coronary artery rupture in severe calcified lesions. The C-CAT sign in the pre-IVUS image may predict coronary artery rupture. If we obtain such a unique IVUS image before intervention, we have to consider using a smaller balloon size, for example a half size down, judging from the vessel diameter of the reference site or using ablation devices such as orbital atherectomy and rotational atherectomy to prevent coronary artery rupture.
The C-CAT sign may predict coronary artery perforation in severe calcified lesions during PCI, although larger registries of such intracoronary pre-perforation imaging are required in order to correlate different signs with outcomes.
冠状动脉破裂是经皮冠状动脉介入治疗（PCI）罕见但致命的并发症。埃利斯III型分类患者的死亡率达19%。既往研究报道过冠状动脉破裂的预测因素。然而，很少有报告从血管内成像如光学相干断层扫描和血管内超声（IVUS）方面显示这种威胁性并发症的危险因素。
我们报告3例冠状动脉破裂患者的病例，他们因严重钙化病变接受了IVUS引导下的PCI。所有3例患者均发生了埃利斯III级破裂，通过使用灌注球囊和覆膜支架成功处理。在这些患者的术前IVUS图像中观察到了共同特征。具体而言，所有3例患者均可见一种特定的钙化和残余薄斑块征象（）。
这些病例为严重钙化病变中的冠状动脉破裂提供了见解。术前IVUS图像中的C-CAT征象可能预测冠状动脉破裂。如果我们在干预前获得这样独特的IVUS图像，就必须考虑使用更小尺寸的球囊，例如根据参考部位的血管直径将尺寸减小一半，或者使用诸如轨道旋磨术和旋切术等消融装置以预防冠状动脉破裂。
C-CAT征象可能预测PCI期间严重钙化病变中的冠状动脉穿孔，尽管需要更大规模的此类冠状动脉穿孔前成像登记研究，以便将不同征象与结果相关联。
