Department of Cardiovascular Medicine, National Hospital Organization Mito Medical Center, Ibaraki, Japan.
Tex Heart Inst J. 2023 Mar 1;50(2). doi: 10.14503/THIJ-22-7883.
Late lumen enlargement after percutaneous coronary intervention (PCI) with drug-coated balloon has contributed to good clinical results. However, late lumen enlargement with drug-coated balloon following rotational atherectomy has not been well reported. This report describes a case of calcified napkin-ring ostial lesion at the left main trunk that showed a sustained lumen area after PCI with drug-coated balloon following rotational atherectomy. An 85-year-old female patient was admitted to the hospital with dyspnea. Echocardiography showed hypokinesis in the anteroseptal and inferior walls. Electrocardiograph-gated cardiac computed tomography showed a calcified ostial lesion in the left main trunk. Invasive angiography of the coronary artery showed severe stenosis in the left main trunk ostium. Percutaneous coronary intervention was performed with a drug-coated balloon after rotational atherectomy. The minimal lumen area measured by intravascular ultrasound grew mildly from 4.09 to 4.17 mm2 immediately after PCI. Follow-up angiography and intravascular ultrasound performed after 6 months showed that the minimal lumen area in the left main trunk ostium was further enlarged from 4.17 to 4.69 mm2. The presence of sustained lumen area after PCI with drug-coated balloon following rotational atherectomy for a napkin-ring left main trunk ostial lesion was confirmed. This case demonstrates sustained lumen area after drug-coated balloon following rotational atherectomy in the left main trunk ostium, improving the patient's chest symptom. Hence, drug-coated balloon after rotational atherectomy may be an option for complex stent sites, such as the left main trunk ostium in geriatric patients and sites with highly calcified lesions.
经皮冠状动脉介入治疗（PCI）后药物涂层球囊晚期管腔扩大有助于获得良好的临床结果。然而，旋磨术后药物涂层球囊晚期管腔扩大的情况尚未得到很好的报道。本报告描述了一例左主干开口处钙化环型病变，在旋磨术后行药物涂层球囊 PCI 后显示持续的管腔面积。一名 85 岁女性患者因呼吸困难入院。超声心动图显示前间隔和下壁运动减弱。心电图门控心脏计算机断层扫描显示左主干开口处钙化病变。冠状动脉血管造影显示左主干开口严重狭窄。在旋磨术之后行药物涂层球囊 PCI。血管内超声测量的最小管腔面积在 PCI 后即刻从 4.09 毫米 2 轻度增加至 4.17 毫米 2。6 个月后的随访血管造影和血管内超声显示左主干开口处的最小管腔面积进一步从 4.17 毫米 2 扩大至 4.69 毫米 2。旋磨术后药物涂层球囊 PCI 后，确认存在持续的管腔面积，用于治疗左主干开口处的环形病变。该病例表明，旋磨术后药物涂层球囊在左主干开口处可以持续扩张管腔，改善患者的胸痛症状。因此，旋磨术后药物涂层球囊可能是老年患者左主干开口等复杂支架部位和高度钙化病变部位的一种选择。
