Bilman Victor, Rosenthal Eyal, Klemperer Leigh, Rubinstein Chen, Halkin Amir, Sheick-Yousif Basheer
Department of Vascular Surgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Department of Cardiology, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
J Endovasc Ther. 2023 Jun 4:15266028231175604. doi: 10.1177/15266028231175604.
To report a case of coronary-subclavian steal syndrome (CSSS) due to a history of a left internal mammary artery (LIMA) to left anterior descending (LAD) artery coronary bypass (CABG) and a heavily calcified ostial left subclavian artery (LSA) occlusion, that was treated with intravascular lithotripsy (IVL) technique and to summarize the current trends of IVL treatment for supra-aortic vessels.
A 64-year-old woman with progressive intermittent angina pectoris and a history of LIMA to LAD bypass underwent coronary angiography which demonstrated complete ostial occlusion of the LSA. Via brachial access, the patient underwent Shockwave IVL balloon treatment of the LSA and stent-graft implantation. At 9 months follow-up, the patient showed symptoms resolution, and duplex ultrasound (DUS) demonstrated a patent LSA.
The Shockwave IVL system was demonstrated to be a feasible treatment and justified for selective cases of highly calcified lesions in supra-aortic vessels. The present case report and the literature review, in a total of 47 patients resulted in a high technical procedural success rate, with a low rate of complications. Future studies with larger cohorts are warranted to confirm these findings and standardize this technology in this particular vascular field.
The present study exemplifies a case of recanalization of the left subclavian artery in a patient with coronary-subclavian steal syndrome with a heavily calcified ostial lesion treated with intravascular lithotripsy (IVL). In this paper, for the first time, a review of the contemporary literature on the use of IVL in supra-aortic vessels is reported, elucidating the feasibility of this technique in this vascular territory. Despite the heterogeneous features of the reported cases and the lack of a standardized protocol for the use of IVL in the management of highly calcified lesions of supra-aortic vessels, it was demonstrated to be a feasible technique, with a high technical success rate, being an advantageous tool for heavily calcified supra-aortic lesions.
报告一例因左乳内动脉（LIMA）至左前降支（LAD）动脉冠状动脉旁路移植术（CABG）病史及左锁骨下动脉（LSA）开口严重钙化闭塞导致的冠状动脉-锁骨下动脉窃血综合征（CSSS）病例，该病例采用血管内碎石术（IVL）技术进行治疗，并总结IVL治疗主动脉弓上血管的当前趋势。
一名64岁女性，有进行性间歇性心绞痛病史，曾行LIMA至LAD旁路移植术，接受冠状动脉造影显示LSA开口完全闭塞。通过肱动脉入路，患者接受了LSA的冲击波IVL球囊治疗及支架移植物植入。随访9个月时，患者症状缓解，双功超声（DUS）显示LSA通畅。
冲击波IVL系统被证明是一种可行的治疗方法，对于主动脉弓上血管高度钙化病变的选择性病例是合理的。本病例报告及文献综述共纳入47例患者，技术操作成功率高，并发症发生率低。需要开展更大样本量的未来研究来证实这些发现并在这个特定血管领域规范这项技术。
本研究举例说明了一名冠状动脉-锁骨下动脉窃血综合征患者的左锁骨下动脉再通病例，该患者的开口病变严重钙化，采用血管内碎石术（IVL）进行治疗。本文首次报道了关于IVL在主动脉弓上血管应用的当代文献综述，阐明了该技术在这个血管区域的可行性。尽管所报道病例具有异质性，且在主动脉弓上血管高度钙化病变管理中使用IVL缺乏标准化方案，但它被证明是一种可行的技术，技术成功率高，是治疗严重钙化的主动脉弓上病变的有利工具。
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