Nakano Takayuki, Ikenaga Hiroki, Takeda Atsushi, Morita Yuichi, Higashihara Tasuku, Watanabe Noriaki, Sada Yoshiharu, Nakano Yukiko
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
Lasers Med Sci. 2024 Dec 16;39(1):295. doi: 10.1007/s10103-024-04265-y.
Excimer laser coronary angioplasty (ELCA) in percutaneous coronary intervention (PCI) is safe and effective. However, thrombotic complications after ELCA occasionally occur. This study aimed to evaluate the impact of lipid-rich plaque in both in-stent restenosis (ISR) and de novo lesions on thrombus formation and transient no-reflow after ELCA. We conducted a single-center, retrospective, observational study including 27 lesions in 26 patients who underwent PCI with ELCA. Optical coherence tomography (OCT) was performed on all lesions before and immediately after ELCA. We measured the lipid angle per millimeter and lipid length of plaques with signal attenuation. We also recorded ELCA-induced thrombus formation and transient no-reflow. Thrombus formation and transient no-reflow were observed in nine (33%) and four lesions (15%), respectively. The frequency of ISR was significantly higher in the no-thrombus group than in the thrombus group. ISR lesions had a significantly lower lipid index (median [interquartile range] 108° [0°-756°] vs. 2541° [1205°-4336°]; p = 0.004) than de novo lesions. Among ISR lesions, those with ELCA-induced thrombus formation had a significantly higher lipid index (1370° [756°-4992°] vs. 29° [0°-285°]; p = 0.01) and significantly longer lipid length (8 mm [7-24 mm] vs. 0.5 mm [0-2.5 mm]; p = 0.01). The findings suggest that thrombus formation was more frequently observed in de novo lesions than in ISR lesions. OCT-detected lipid-rich plaques in ISR lesions were strongly associated with thrombus formation following ELCA.
准分子激光冠状动脉成形术（ELCA）用于经皮冠状动脉介入治疗（PCI）是安全有效的。然而，ELCA术后血栓形成并发症偶尔会发生。本研究旨在评估富含脂质斑块在支架内再狭窄（ISR）和初发病变中对ELCA术后血栓形成和短暂无复流的影响。我们进行了一项单中心、回顾性、观察性研究，纳入了26例接受ELCA PCI治疗的患者的27处病变。在ELCA术前及术后即刻对所有病变进行光学相干断层扫描（OCT）。我们测量了信号衰减斑块每毫米的脂质角度和脂质长度。我们还记录了ELCA诱导的血栓形成和短暂无复流情况。分别在9处（33%）和4处病变（15%）观察到血栓形成和短暂无复流。无血栓组的ISR发生率显著高于血栓组。ISR病变的脂质指数（中位数[四分位间距]108°[0°-756°] vs. 2541°[1205°-4336°]；p = 0.004）显著低于初发病变。在ISR病变中，发生ELCA诱导血栓形成的病变脂质指数显著更高（1370°[756°-4992°] vs. 29°[0°-285°]；p = 0.01），脂质长度显著更长（8 mm[7-24 mm] vs. 0.5 mm[0-2.5 mm]；p = 0.01）。这些发现表明，初发病变中血栓形成的观察频率高于ISR病变。OCT检测到的ISR病变中富含脂质的斑块与ELCA术后血栓形成密切相关。
