Kawai Yoshiki, Ando Jiro, Warisawa Takayuki
Department of Cardiology, NTT Medical Center Tokyo, Tokyo, Japan.
Catheter Cardiovasc Interv. 2025 Aug;106(2):1378-1382. doi: 10.1002/ccd.31688. Epub 2025 Jun 18.
The use of debulking devices in saphenous vein graft (SVG) interventions is generally contraindicated due to the risk of vascular injury, making the treatment of heavily calcified lesions challenging. We report the case of a 73-year-old man who developed unstable angina 26 years after coronary artery bypass grafting. Urgent coronary angiography revealed severe calcification and critical stenosis at the SVG-to-left anterior descending artery (LAD) anastomosis. Intravascular ultrasound demonstrated a calcified nodule at the anastomosis and circumferential calcification in the mid-LAD. Balloon angioplasty was attempted but failed due to inadequate lesion dilation. To facilitate lesion modification, an orbital atherectomy system (OAS) was delivered using a guide extension catheter (GEC). Multiple ablations were performed, followed by successful balloon angioplasty and application of a drug-coated balloon. The patient was discharged 3 days later without complications. This case suggests that GEC-supported OAS may be a safe and effective option for treating heavily calcified SVG lesions.
由于存在血管损伤风险，大隐静脉移植血管（SVG）介入治疗中通常禁忌使用减容装置，这使得严重钙化病变的治疗具有挑战性。我们报告了一例73岁男性患者，他在冠状动脉搭桥术后26年出现不稳定型心绞痛。紧急冠状动脉造影显示SVG至左前降支（LAD）吻合处严重钙化并伴有严重狭窄。血管内超声显示吻合处有钙化结节，LAD中段有环形钙化。尝试进行球囊血管成形术，但由于病变扩张不充分而失败。为便于病变处理，使用导引导管延长导管（GEC）输送了轨道旋磨术系统（OAS）。进行了多次消融，随后成功进行了球囊血管成形术并应用了药物涂层球囊。患者3天后出院，无并发症。该病例表明，GEC辅助的OAS可能是治疗严重钙化SVG病变的一种安全有效的选择。
