经皮冠状动脉介入治疗期间钙形态的潜在危险：卡压与穿孔
The Hidden Dangers of Calcium Morphology During PCI: Entrapment and Perforation.
作者信息
Yi Teh Xin, Hsieh I Chang, Yeh Jih Kai
机构信息
School of Medicine, National Defense Medical Center, Taipei, Taiwan.
Division of Cardiology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan.
出版信息
JACC Case Rep. 2025 Jun 4;30(13):103626. doi: 10.1016/j.jaccas.2025.103626.
BACKGROUND
The management of calcified coronary artery disease (CAD) during percutaneous coronary intervention (PCI) can lead to complications.
CASE SUMMARY
A 72-year-old man had exertional dyspnea and severe calcified coronary artery disease (CAD) identified by means of coronary computed tomographic angiography (CTA). During PCI, a burr became entrapped in the mid left anterior descending artery (LAD) and was retrieved with the use of the push-and-pull technique. The procedure was further complicated by coronary perforation in the distal LAD during balloon angioplasty.
DISCUSSION
Imaging review revealed eccentric calcification with a "nutcracker" appearance in the mid-LAD, indicating a risk for burr entrapment, and a "waning crescent" calcium nodule in the distal LAD, which warranted a higher risk of perforation.
TAKE-HOME MESSAGES: This case emphasizes the importance of early identification of high-risk calcium morphology with the use of imaging, including CTA and intravascular ultrasound to prevent procedural complications during PCI.
背景
经皮冠状动脉介入治疗（PCI）期间钙化冠状动脉疾病（CAD）的处理可能导致并发症。
病例摘要
一名72岁男性出现劳力性呼吸困难，通过冠状动脉计算机断层血管造影（CTA）确诊为严重钙化冠状动脉疾病（CAD）。在PCI过程中，一个旋磨头被困在左前降支（LAD）中段，采用推拉技术将其取出。在球囊血管成形术期间，LAD远端发生冠状动脉穿孔，使手术进一步复杂化。
讨论
影像学检查显示，LAD中段有偏心钙化，呈“胡桃夹”样外观，提示有旋磨头被困风险；LAD远端有一个“新月形缩小”的钙结节，提示穿孔风险较高。
经验教训
该病例强调了利用包括CTA和血管内超声在内的影像学手段早期识别高危钙化形态对于预防PCI期间手术并发症的重要性。
Zotero 插件