Jinnouchi Hiroyuki, Sakakura Kenichi, Fujita Hideo
Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, 1-847, Amanuma-cho, Omiya-ku, Saitama, Japan.
Cardiovasc Interv Ther. 2025 Apr;40(2):234-244. doi: 10.1007/s12928-025-01096-8. Epub 2025 Feb 3.
Percutaneous coronary intervention has been developed for patients with coronary artery disease. Calcified lesions are recognized as an unsolved issue where many clinical devices have evolved and some disappeared. Understanding intracoronary imaging of the calcified lesions can help operators to make decisions during the procedure. There are several potential stories of progression of calcification, although a precise mechanism of progression of calcification remains unknown. In the process of a large calcification, it is histologically believed that lipid is replaced by calcification. This process can be observed by intracoronary imaging devices, i.e., intravascular ultrasound and optical coherence tomography. Calcified nodule is a unique type of calcifications. Among the calcified lesions, especially calcified nodule has serious clinical outcomes such as target lesion revascularization (TLR) with stent under-expansion. Additionally, in-stent calcified nodule is a distinctive type of restenosis pattern after stenting to calcified nodule, leading to malignant cycle of repeated TLR. Recently, calcified nodule is divided into two types based on the surface irregularity: (1) eruptive and (2) non-eruptive calcified nodule. Eruptive calcified nodule has higher rate of target vessel revascularization than non-eruptive calcified nodule despite greater stent expansion in eruptive calcified nodule. It is thought that there are differences of component such as the amount of fibrin and the size of calcific nodules between both, although it is common for both to include calcific nodules and fibrin. Histopathological understanding calcified nodule can be helpful to choose the treatment devices during the procedure in the area where there is no correct answer.
经皮冠状动脉介入治疗已应用于冠状动脉疾病患者。钙化病变被认为是一个尚未解决的问题，许多临床设备在这方面不断发展，有些甚至被淘汰。了解钙化病变的冠状动脉内成像有助于操作人员在手术过程中做出决策。钙化进展有几种潜在情况，尽管钙化进展的确切机制尚不清楚。在大钙化过程中，从组织学角度来看，脂质被钙化所取代。这一过程可通过冠状动脉内成像设备观察到，即血管内超声和光学相干断层扫描。钙化结节是一种独特的钙化类型。在钙化病变中，尤其是钙化结节具有严重的临床后果，如支架扩张不全导致的靶病变血运重建（TLR）。此外，支架内钙化结节是支架置入钙化结节后一种独特的再狭窄模式，会导致反复TLR的恶性循环。最近，根据表面不规则性，钙化结节分为两种类型：（1）爆发性和（2）非爆发性钙化结节。尽管爆发性钙化结节的支架扩张程度更大，但其靶血管血运重建率高于非爆发性钙化结节。虽然两者都含有钙化结节和纤维蛋白，但人们认为两者在纤维蛋白含量和钙化结节大小等成分上存在差异。对钙化结节的组织病理学理解有助于在没有正确答案的区域选择手术过程中的治疗设备。
