报告一例因左乳内动脉(LIMA)至左前降支(LAD)冠状动脉搭桥术(CABG)和严重钙化的口左锁骨下动脉(LSA)闭塞而导致的冠状动脉锁骨下动脉盗血综合征(CSSS)。采用血管内碎石术(IVL)技术治疗,并总结主动脉上血管IVL治疗的当前趋势。
■一名64岁女性,有进行性间歇性心绞痛和LIMA至LAD旁路手术史,接受了冠状动脉造影检查,显示LSA的口完全闭塞。通过肱动脉通路,患者接受了LSA的ShockwaveIVL球囊治疗和支架植入术.在9个月的随访中,患者表现出症状消退,和双工超声(DUS)证明了专利LSA。
■ShockwaveIVL系统被证明是一种可行的治疗方法,适用于主动脉上血管高度钙化病变的选择性病例。本病例报告及文献复习,在总共47名患者中,技术程序成功率很高,并发症发生率低。未来的研究与更大的队列是必要的,以证实这些发现和标准化这项技术在这个特定的血管领域。
结论:本研究举例说明了1例冠状动脉-锁骨下动脉盗血综合征伴严重钙化的窦口病变经血管内碎石术(IVL)治疗的患者左锁骨下动脉再通的情况。在本文中,第一次,对在主动脉上血管中使用IVL的当代文献进行了综述,阐明该技术在该血管区域中的可行性。尽管报道的病例具有异质性特征,并且缺乏在主动脉上血管高度钙化病变的管理中使用IVL的标准化方案,它被证明是一种可行的技术,具有很高的技术成功率,是严重钙化的主动脉上病变的有利工具。
UNASSIGNED: To report a
case of coronary-subclavian steal syndrome (CSSS) due to a history of a left internal mammary artery (LIMA) to left anterior descending (LAD) artery coronary bypass (CABG) and a heavily calcified ostial left subclavian artery (LSA) occlusion, that was treated with intravascular lithotripsy (IVL) technique and to summarize the current trends of IVL treatment for supra-aortic vessels.
UNASSIGNED: A 64-year-old woman with progressive intermittent angina pectoris and a history of LIMA to LAD bypass underwent coronary angiography which demonstrated complete ostial occlusion of the LSA. Via brachial access, the patient underwent Shockwave IVL balloon treatment of the LSA and stent-graft implantation. At 9 months follow-up, the patient showed symptoms resolution, and duplex ultrasound (DUS) demonstrated a patent LSA.
UNASSIGNED: The Shockwave IVL system was demonstrated to be a feasible treatment and justified for selective cases of highly calcified lesions in supra-aortic vessels. The present
case report and the literature review, in a total of 47 patients resulted in a high technical procedural success rate, with a low rate of complications. Future studies with larger cohorts are warranted to confirm these findings and standardize this technology in this particular vascular field.
CONCLUSIONS: The present study exemplifies a
case of recanalization of the left subclavian artery in a patient with coronary-subclavian steal syndrome with a heavily calcified ostial lesion treated with intravascular lithotripsy (IVL). In this paper, for the first time, a review of the contemporary literature on the use of IVL in supra-aortic vessels is reported, elucidating the feasibility of this technique in this vascular territory. Despite the heterogeneous features of the reported cases and the lack of a standardized protocol for the use of IVL in the management of highly calcified lesions of supra-aortic vessels, it was demonstrated to be a feasible technique, with a high technical success rate, being an advantageous tool for heavily calcified supra-aortic lesions.