Lupu Lior, Hashim Hayder D, Haberman Dan, Chitturi Kalyan R, Abusnina Waiel, Chaturvedi Abhishek, Satler Lowell F, Waksman Ron, Ben-Dor Itsik
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, District of Columbia, USA.
Catheter Cardiovasc Interv. 2024 Dec;104(7):1434-1441. doi: 10.1002/ccd.31268. Epub 2024 Oct 17.
Underexpanded stents are a dreaded complication of percutaneous coronary intervention (PCI) and are a major predictor of stent thrombosis and in-stent restenosis. Lesion preparation and plaque modification before stent implantation are essential to prevent stent underexpansion and optimize the technical outcomes of PCI. Once stent underexpansion occurs, the treatment options are limited. New devices for the treatment of complex calcified lesions have emerged in the past few years, and experience has accumulated with their use in the treatment of underexpanded stents. This review aims to provide an evidence-based, practical summary of the approach to stent underexpansion, with particular attention to the expected luminal gain, complication rates, and technical nuances of various treatment options. These modalities include the ultrahigh pressure OPN noncompliant balloon, excimer laser coronary angioplasty, rotational and orbital atherectomy, and intravascular lithotripsy. The data gathered for each of these modalities and our experience in treating this complex condition were used to formulate a treatment algorithm for such cases.
支架扩张不足是经皮冠状动脉介入治疗（PCI）中令人担忧的并发症，是支架血栓形成和支架内再狭窄的主要预测因素。在支架植入前进行病变预处理和斑块修饰对于预防支架扩张不足和优化PCI的技术效果至关重要。一旦发生支架扩张不足，治疗选择就很有限。在过去几年中出现了用于治疗复杂钙化病变的新设备，并且在使用它们治疗扩张不足的支架方面积累了经验。本综述旨在提供基于证据的、关于支架扩张不足处理方法的实用总结，特别关注各种治疗选择的预期管腔增益、并发症发生率和技术细节。这些方式包括超高压OPN非顺应性球囊、准分子激光冠状动脉成形术、旋磨术和轨道旋切术以及血管内碎石术。为这些方式中的每一种收集的数据以及我们治疗这种复杂情况的经验被用于制定此类病例的治疗算法。
