Koide Masahiro, Fukui Kento, Sugimoto Hikaru, Takeda Yuki, Sogabe Koji, Kato Yukinori, Kitajima Hiroki, Akabame Satoshi
Department of Cardiovascular Medicine, Kyoto Okamoto Memorial Hospital, Kyoto, Japan.
Case Rep Cardiol. 2023 Aug 14;2023:6894610. doi: 10.1155/2023/6894610. eCollection 2023.
The Impella, a percutaneous left ventricular assist device, has been reported to minimize the risk of hemodynamic compromise and improve clinical outcomes during percutaneous coronary intervention (PCI) in complex high-risk indicated patients (CHIPs). Optical coherence tomography (OCT) provides information on calcified plaque thickness, which is helpful in determining the indication and endpoint of atherectomy during PCI for calcified lesions. However, there are few reports on OCT-guided aggressive rotational atherectomy with Impella assistance in CHIPs. A 71-year-old man on dialysis for end-stage renal failure was admitted for congestive heart failure. Transthoracic echocardiography revealed severe left ventricular systolic dysfunction, and coronary angiography performed after improvement of heart failure showed severe stenosis with heavily calcified lesions in the left main trunk (LMT) bifurcation and right coronary artery. The patient refused coronary artery bypass surgery and was revascularized using PCI. PCI was started with prophylactic Impella CP insertion because of the high risk of hemodynamic collapse. After OCT-guided rotational atherectomy with 1.5- and 2.0-mm burr toward the left anterior descending artery and left circumflex artery, respectively, double-kissing culotte stenting was performed in the LMT, and good dilation was obtained. Impella CP was removed immediately after PCI without hemodynamic compromise, and the procedure was completed.
据报道，经皮左心室辅助装置Impella可将复杂高危患者（CHIPs）在经皮冠状动脉介入治疗（PCI）期间发生血流动力学损害的风险降至最低，并改善临床结局。光学相干断层扫描（OCT）可提供有关钙化斑块厚度的信息，这有助于确定钙化病变PCI期间旋磨术的适应症和终点。然而，关于在CHIPs中使用Impella辅助进行OCT引导下积极旋磨术的报道很少。一名因终末期肾衰竭接受透析的71岁男性因充血性心力衰竭入院。经胸超声心动图显示严重的左心室收缩功能障碍，心力衰竭改善后进行的冠状动脉造影显示左主干（LMT）分叉和右冠状动脉严重狭窄并伴有严重钙化病变。患者拒绝冠状动脉搭桥手术，采用PCI进行血运重建。由于存在血流动力学崩溃的高风险，预防性插入Impella CP后开始PCI。在分别使用1.5毫米和2.0毫米的磨头对左前降支和左旋支进行OCT引导下的旋磨术后，在LMT中进行了双吻挤压支架置入术，并获得了良好的扩张效果。PCI术后立即移除Impella CP，未出现血流动力学损害，手术完成。
