Combaret Nicolas, Amabile Nicolas, Duband Benjamin, Motreff Pascal, Souteyrand Géraud
Cardiology Department, Clermont-Ferrand University Hospital, CNRS, Université d'Auvergne, 63000 Clermont-Ferrand, France.
Cardiology Department, Institut Mutualiste Montsouris, 75014 Paris, France.
Rev Cardiovasc Med. 2023 Mar 20;24(3):93. doi: 10.31083/j.rcm2403093. eCollection 2023 Mar.
Coronary artery calcification is a complex process found predominantly in the elderly population. Coronary angiography frequently lacks sensitivity to detect, evaluate and quantify these lesions. Yet calcified lesions are considered stable, it remains associated with a higher rate of peri procedural complications during percutaneous coronary intervention (PCI) including an increased risk of stent under expansion and struts mal apposition leading to poor clinical outcome. Intracoronary imaging (Intravascular Ultra Sound (IVUS) and Optical Coherence Tomography (OCT)) allows better calcified lesions identification, localization within the coronary artery wall (superficial or deep calcifications), quantification. This lesions characterization allows a better choice of dedicated plaque-preparation tools (modified balloons, rotational or orbital atherectomy, intravascular lithotripsy) that are crucial to achieve optimal PCI results. OCT could also assess the impact of these tools on the calcified plaque morphology (plaque fracture, burring effects…). An OCT-guided tailored PCI strategy for calcified lesions still requires validation by clinical studies which are currently underway.
冠状动脉钙化是一个主要在老年人群中发现的复杂过程。冠状动脉造影常常缺乏检测、评估和量化这些病变的敏感性。然而，尽管钙化病变被认为是稳定的，但在经皮冠状动脉介入治疗（PCI）期间，它仍与较高的围手术期并发症发生率相关，包括支架扩张不足和支柱贴壁不良的风险增加，从而导致不良的临床结局。冠状动脉内成像（血管内超声（IVUS）和光学相干断层扫描（OCT））能够更好地识别钙化病变，确定其在冠状动脉壁内的位置（浅表或深部钙化）并进行量化。这种病变特征描述有助于更好地选择专用的斑块预处理工具（改良球囊、旋磨或轨道旋切术、血管内碎石术），这些工具对于实现最佳PCI结果至关重要。OCT还可以评估这些工具对钙化斑块形态的影响（斑块破裂、打磨效果……）。针对钙化病变的OCT引导下的个体化PCI策略仍需通过目前正在进行的临床研究来验证。
