Angelini Paolo, Uribe Carlo
The Texas Heart Institute Center for Cardiovascular Care, Houston, Texas.
J Soc Cardiovasc Angiogr Interv. 2023 Feb 16;2(3):100595. doi: 10.1016/j.jscai.2023.100595. eCollection 2023 May-Jun.
Although coronary artery anomalies include multiple disorders, few are likely to require intervention, given that the risk for critical sequelae (ie, sudden cardiac arrest and sudden cardiac death) is generally low. This article addresses which coronary artery anomaly carriers may need intervention and which interventions may be required. The recent introduction of stent angioplasty is discussed in particular, along with general reviews of nomenclature, various anatomical and functional presentations, quantitative diagnosis methods, and indications for surgical versus percutaneous intervention. Novel criteria for defining severe stenosis also are proposed. Optimal risk quantification depends on precise imaging that only intravascular ultrasonography or optical coherence tomography can reliably obtain. Accordingly, the technique of intravascular ultrasonography-monitored stent angioplasty is described in detail. Initial results from our group's study of 100 patients with right or left anomalous origin of a coronary artery from an opposite sinus of Valsalva with intramural course are reported. Future efforts should prospectively evaluate stent angioplasty in multicenter studies based on precise, consistent techniques and follow-up protocols, such as those initiated by our group. Comparisons with surgical results should be part of the program, with the understanding that detailed and complete results from those techniques will require long-term (5- to 10-year) studies.
尽管冠状动脉异常包括多种病症，但鉴于严重后遗症（即心脏骤停和心源性猝死）的风险通常较低，很少有情况可能需要干预。本文探讨哪些冠状动脉异常携带者可能需要干预以及可能需要哪些干预措施。特别讨论了支架血管成形术的近期应用，同时对命名法、各种解剖和功能表现、定量诊断方法以及手术与经皮介入的适应症进行了综述。还提出了定义严重狭窄的新标准。最佳风险量化取决于仅血管内超声或光学相干断层扫描才能可靠获得的精确成像。因此，详细描述了血管内超声监测下的支架血管成形术技术。报告了我们小组对100例冠状动脉从对侧瓦尔萨尔瓦窦异常起源且走行于心肌内的患者的研究初步结果。未来的工作应基于精确、一致的技术和随访方案，如我们小组发起的方案，在前瞻性多中心研究中评估支架血管成形术。与手术结果的比较应作为该计划的一部分，同时要明白这些技术的详细和完整结果需要长期（5至10年）研究。
