Sekimoto Teruo, Fujiyoshi Kazuhiro, Kawakami Rika, Madra Anna, Tanaka Takamasa, Shin Doosup, Wolff Eric H, Shiraki Tatsuya, Nakayama Takafumi, Hamana Tomoyo, Virmani Renu, Ali Ziad A, Finn Aloke V
CVPath Institute, Gaithersburg, Maryland, USA.
St. Francis Hospital and Heart Center, Roslyn, New York, USA.
JACC Cardiovasc Interv. 2025 Sep 8;18(17):2093-2104. doi: 10.1016/j.jcin.2025.06.035.
Effective modification of heavily calcified coronary lesions is critical for successful percutaneous coronary intervention (PCI). Intravascular lithotripsy (IVL), cutting balloons (CBs), and ultra-high-pressure balloons (UHBs) are used commonly, yet data comparing their effectiveness and safety for calcified lesion modification remain unavailable.
The aim of this study was to compare the effects of IVL, a CB, and a UHB on calcified coronary lesions in human cadaveric arteries, focusing on calcium fracture formation and vascular injury.
Seventeen calcified lesions from 6 cadavers were randomized to treatment with IVL (n = 5), the CB (n = 6), or the UHB (n = 6). Pre- and post-treatment optical coherence tomography, micro-computed tomography (CT), and histology were coregistered to evaluate calcium fractures and medial injury.
Fractures confirmed by micro-CT and histology were observed in 80% of IVL-treated lesions, 66.7% treated with the CB, and 33.3% treated with the UHB (P = 0.350). Medial injury occurred significantly less frequently with IVL (20.0%) compared with the CB (83.3%) and the UHB (100%) (P = 0.012). In histologic sections with a calcium arc of ≥180°, IVL induced fractures in 100% of sections, all without medial injury, while the CB and UHB caused fractures without medial injury in 16.7% and 20.0% of sections, respectively (P = 0.007). For calcium arcs <180°, IVL produced fractures in 57.1% of sections, all without medial injury, compared with the CB (11.1% without medial injury) and UHB (0% without medial injury) (P = 0.008).
IVL effectively modifies calcified lesions with less medial vascular injury compared with a CB and a UHB.
有效处理严重钙化的冠状动脉病变对于经皮冠状动脉介入治疗（PCI）的成功至关重要。血管内碎石术（IVL）、切割球囊（CB）和超高压球囊（UHB）均被广泛应用，但比较它们在钙化病变处理方面有效性和安全性的数据仍然缺乏。
本研究旨在比较IVL、CB和UHB对人体尸体动脉钙化冠状动脉病变的影响，重点关注钙断裂的形成和血管损伤。
将来自6具尸体的17处钙化病变随机分为IVL治疗组（n = 5）、CB治疗组（n = 6）或UHB治疗组（n = 6）。治疗前后进行光学相干断层扫描、微计算机断层扫描（CT）和组织学检查，以评估钙断裂和中层损伤情况。
经微CT和组织学证实，IVL治疗的病变中有80%出现骨折，CB治疗的病变中有66.7%出现骨折，UHB治疗的病变中有33.3%出现骨折（P = 0.350）。与CB（83.3%）和UHB（100%）相比，IVL导致的中层损伤发生率显著更低（20.0%）（P = 0.012）。在钙弧≥180°的组织学切片中，IVL在100%的切片中诱导骨折，且均无中层损伤，而CB和UHB分别在16.7%和20.0%的切片中导致无中层损伤的骨折（P = 0.007）。对于钙弧<180°的情况，IVL在57.1%的切片中产生骨折，且均无中层损伤，而CB（无中层损伤的为11.1%）和UHB（无中层损伤的为0%）（P = 0.008）。
与CB和UHB相比，IVL能更有效地处理钙化病变，且对血管中层的损伤更小。
