光学相干断层成像与血管内超声指导下冲击波血管内碎石术治疗冠状动脉钙化病变的有效性分析

Effectiveness of shockwave intravascular lithotripsy under the guidance of optical coherence tomography and intravascular ultrasound in treating coronary artery calcification

摘要:

目的 分析光学相干断层成像（OCT）与血管内超声（IVUS）指导下冲击波血管内碎石术（IVL）治疗冠状动脉钙化（CAC）病变的有效性。方法 选取2021年2月—2024年2月南京医科大学附属淮安第一医院心血管内科收治的98例CAC病变患者（104个病变），按治疗方法不同分为两组，对照组47例（51个病变）予以IVUS指导下IVL，观察组51例（53个病变）予以OCT指导下IVL，比较两组治疗效果。结果 观察组和对照组手术成功率均为100.00%。观察组与对照组预扩张球囊直径、预扩张球囊最大压力、支架植入数、支架直径、总支架长度、后扩球囊直径、后扩球囊最大压力和手术时间比较，差异均无统计学意义（P >0.05）。观察组与对照组近端参考血管最小管腔直径（MLD）、最大管腔直径（MaxLD）、管腔面积，远端参考血管MLD、管腔面积、参考面积，病变处MaxLD、最小管腔面积（MLA）比较，差异均无统计学意义（P >0.05）；观察组远端参考血管MaxLD、病变处MLD均低于对照组（P <0.05）。观察组与对照组治疗前后病变血管内径和血管狭窄率的差值比较，差异均无统计学意义（P >0.05）。观察组与对照组心肌梗死溶栓试验血流分级比较，差异无统计学意义（P >0.05）。观察组不良事件总发生率低于对照组（P <0.05）。结论 OCT与IVUS对指导IVL治疗CAC病变具有重要作用，OCT指导下的IVL不良事件发生率更低。

Abstract:

Objective To evaluate the effectiveness of shockwave intravascular lithotripsy (IVL) under the guidance of optical coherence tomography (OCT) and intravascular ultrasound (IVUS) in the treatment of patients with coronary artery calcification (CAC).Methods A total of 98 patients with CAC lesions (104 lesions) admitted to the Department of Cardiovascular Medicine of Huai’an First Hospital Affiliated to Nanjing Medical University from February 2021 to February 2024 were divided into two groups according to different treatment methods. The 47 patients in the control group (51 lesions) were given IVUS-guided IVL, while the 51 cases (53 lesions) in the observation group were given OCT-guided IVL. The treatment effect of the two groups was compared.Results The success rates of operation in the observation group and the control group were both 100.00%. There was no significant difference in the pre-dilation balloon diameter, maximum pre-dilation balloon pressure, number of stents implanted, stent diameter, total stent length, post-dilation balloon diameter, maximum post-dilation balloon pressure, or procedure time between the observation group and the control group (P > 0.05). There was no significant difference between the observation group and the control group in the proximal reference vessel minimal lumen diameter (MLD), maximal lumen diameter (MaxLD), and lumen area, distal reference vessel MLD, lumen area, and reference area, or lesion-site MaxLD and minimal lumen area (MLA) (P > 0.05). The distal reference vessel MaxLD and lesion-site MLD in the observation group were both smaller than those in the control group (P < 0.05). There were no statistically significant differences between the observation group and the control group in the changes in lesion vessel diameter or the degree of vessel stenosis before and after treatment (P > 0.05). There was no significant difference in thrombolysis in myocardial infarction flow grades between the observation group and the control group (P > 0.05). The incidence of adverse events in the observation group was lower than that in the control group (P < 0.05).Conclusion Both OCT and IVUS play important roles in guiding IVL for the treatment of CAC lesions, and OCT-guided IVL is associated with a lower incidence of adverse events.