Sasi Viktor, Szántó Gyula, Achim Alexandru, Ungi Imre, Varga Albert, Ruzsa Zoltán
Department of Internal Medicine, Medical Faculty, Division of Invasive Cardiology, Hungary Albert Szent-Györgyi Clinical Center, University of Szeged Szeged, Hungary.
Department of Interventional Cardiology, Medicala 1 Clinic, Iuliu Hațieganu University of Medicine and Pharmacy Cluj-Napoca, Romania.
Interv Cardiol. 2023 Jul 25;18:e23. doi: 10.15420/icr.2022.36. eCollection 2023.
Patients with calcified, fibrotic native coronary vessels with prior suboptimal stenting outcomes are at major risk of stent thrombosis and could face serious consequences if untreated. In cases of multiple layers of under-expanded stents, the risk is multiplied. If conventional balloon post-dilatation is unsuccessful after stent implantation without proper lesion preparation, few interventional options remain. The authors report on a patient with prior numerous right coronary unsuccessful coronary interventions resulting in partially crushed multiple layers of stent material with critical lumen narrowing caused by stent under-expansion. Balloon angioplasty and stent rotational atherectomy (ROTA) had been attempted to overcome stent under-expansion but were unsuccessful. The authors investigated a new combination therapy of laser atherectomy (ELCA) and super high-pressure balloon (OPN non-compliant balloon) to treat single or multiple layers of stent with severe under-expansion due to fibrotic, calcified tissue surrounding the under-expanded stent structure.
患有钙化、纤维化的自身冠状动脉且既往支架置入效果欠佳的患者面临支架血栓形成的重大风险，若不治疗可能会面临严重后果。在多层支架扩张不足的情况下，风险会成倍增加。如果在未对病变进行适当预处理的情况下，支架植入后传统球囊后扩张不成功，那么可供选择的介入方法就很少了。作者报告了一例患者，该患者既往多次右冠状动脉介入治疗均未成功，导致多层支架材料部分受压，因支架扩张不足致使管腔严重狭窄。曾尝试进行球囊血管成形术和支架旋磨术（ROTA）以克服支架扩张不足，但均未成功。作者研究了一种新的联合治疗方法，即准分子激光消蚀术（ELCA）和超高压球囊（OPN非顺应性球囊），用于治疗因支架扩张不足结构周围存在纤维化、钙化组织而导致严重扩张不足的单层或多层支架。
