摘要目的 探讨准分子激光冠状动脉斑块消蚀术(ELCA)在急性冠状动脉综合征(ACS)经皮冠状动脉介入治疗(PCI)中应用的效果.方法 采用前瞻性研究方法,入选2016年11月8日至2017年12月13日在沈阳军区总医院接受ELCA治疗的ACS患者31例.观察ELCA的疗效和并发症,并在PCI后对患者进行随访,观察主要不良心脑血管事件(包括靶血管血运重建、卒中、支架内血栓形成、行冠状动脉旁路移植术和死亡)的发生情况.结果 患者年龄(65.0±10.8)岁,男性25例(80.6％).ST段抬高型心肌梗死5例(16.1％),非ST段抬高型心肌梗死3例(9.7％),不稳定型心绞痛23例(74.2％).支架内再狭窄9例(29.0％),静脉桥血管病变11例(35.5％),慢性完全闭塞病变2例(6.5％),钙化病变4例(12.9％).其中2例慢性完全闭塞病变和1例钙化病变使用血管内超声进行检查,其余病变均未采用血管内超声或光学相干断层成像检查.ELCA成功率为100％(31/31),PCI成功率为100％(31/31).术中使用直径0.9 mm导管12例(38.7％),使用直径1.7 mm导管10例(32.3％),使用直径1.4 mm导管9例(29.0％).1例ST段抬高型心肌梗死患者在术中出现冠状动脉无复流,其余30例患者术中未发生穿孔、小夹层、大夹层、远端闭塞、慢血流和侧支闭塞等并发症.术后随访(6.4±1.9)个月,1例(3.2％)患者发生心原性死亡.结论 初步研究表明,在ACS介入治疗中应用ELCA安全、有效.

abstractsObjective To investigate the effect of excimer laser coronary atherectomy (ELCA) in the interventional treatment of acute coronary syndrome (ACS).Methods This prospective study enrolled 31 patients with ACS who underwent ELCA treatment in our hospital from November 8,2016 to December 13,2017.The efficacy and complications of ELCA were observed,and patients were followed up for postoperative observation of major adverse cardiovascular and cerebrovascular events (including target vessel revascularization,stroke,stent thrombosis,coronary artery bypass grafting,and death).Results The patients were aged (65.0±10.8) years old and 25 were males (80.6％).There were 5 cases (16.1％) ST-segment elevation myocardial infarction,3 cases (9.7％) non-ST-segment elevation myocardial infarction,and 23 cases (74.2％) unstable angina in this cohort.There were 9 cases (29.0％) in-stent restenosis,11 cases (35.5％) saphenous vein graft,2 cases (6.5％) chronic total occlusive disease,and 4 cases (12.9％) calcification.Two patients with chronic complete occlusive disease and 1 patient with calcified lesion were examined by intravascular ultrasound (IVUS).The other lesions were not examined with IVUS and optical correlation tomography (OCT).The ELCA success rate was 100％ (31/3 1) and the PCI success rate was 100％ (31 / 31).Intraoperative use of 0.9 mm diameter catheters accounted for 38.7％ (12 / 31),1.7 mm diameter catheters accounted for 32.3％ (10/31),and 1.4 mm diameter catheters accounted for 29.0％ (9/31).One patient with ST-segment elevation myocardial infarction experienced no reflow of coronary artery during operation.The other 30 patients had no complications such as perforation,small dissection,large dissection,distal occlusion,slow blood flow and collateral occlusion.One cardiac death(3.2％) occurred during the postoperative follow-up of (6.4± 1.9) months.Conclusion Our preliminary study results indicate that the use of ELCA in the interventional therapy of ACS is safe and effective.