Department of Cardiology, The People's Hospital of Liaoning Province, Wenyi Road, Shenhe, Shenyang, Liaoning Province, 110016, China.
J Cardiothorac Surg. 2024 May 4;19(1):277. doi: 10.1186/s13019-024-02782-z.
Intravascular lithotripsy (IVL) represents a novel approach in the management of coronary calcification. This technique employs acoustic pressure waves, generated by a shockwave balloon, to effectively fracture both superficial and deep calcification in situ. The efficacy and safety of IVL have been convincingly demonstrated through the Disrupt CAD I-IV studies. While IVL is associated with the occurrence of atrial and ventricular arrhythmias, there is no evidence to indicate it causes myocardial ischemia.
A 71-year-old man was admitted presenting with chest pain. His previous coronary angiography revealed stenosis and calcification in the left anterior descending branch. An attempt to predilate the lesion using two Lacrosse non-slip element balloons was unsuccessful. Ventricular premature beats and transient ST-segment depression were captured during the utilization of IVL. The operator gradually extended the pulse emission interval across two consecutive cycles to mitigate myocardial ischemia. Notably, when the interval reached 30s, the patient had no chest pain or ST-segment changes. Subsequent images of intravascular ultrasound confirmed calcification ruptures. Therapeutic intervention included the placement of a stent and the application of a drug-coated balloon in the left anterior descending branch. A telephonic follow-up six months later indicated the patient had no discomfort.
This case underscores the effectiveness of gradually extending the pulse emission interval as a strategic complement to the clinical application of IVL. In certain clinical scenarios, it may become imperative to suspend the pulse delivery to improve myocardial blood supply.
血管内碎石术（IVL）代表了一种治疗冠状动脉钙化的新方法。该技术采用冲击波球囊产生的声压波，有效地将浅表和深部钙化原位碎裂。Disrupt CAD I-IV 研究有力地证明了 IVL 的疗效和安全性。虽然 IVL 与房性和室性心律失常的发生有关，但没有证据表明它会引起心肌缺血。
一名 71 岁男性因胸痛入院。他之前的冠状动脉造影显示左前降支狭窄和钙化。使用两个 Lacrosse 非滑元件球囊预扩张病变的尝试均未成功。在使用 IVL 时，记录到室性早搏和短暂的 ST 段压低。操作者逐渐将脉冲发射间隔延长两个连续周期，以减轻心肌缺血。值得注意的是，当间隔达到 30 秒时，患者没有胸痛或 ST 段变化。血管内超声的后续图像证实了钙化破裂。治疗干预包括在左前降支放置支架和应用药物涂层球囊。六个月后的电话随访显示患者没有不适。
本病例强调了逐渐延长脉冲发射间隔作为 IVL 临床应用的一种策略补充的有效性。在某些临床情况下，可能需要暂停脉冲输送以改善心肌血液供应。
