Intima calcification is common in elderly patients with coronary heart disease. Circular calcification greater than 270° will seriously hinder stent implantation. Forcible stent implantation may cause serious complications such as coronary perforation. What should I do? Recently, Granny Li, an 83-year-old patient with coronary heart disease, suffered a sudden myocardial infarction like this. The situation was urgent. Fortunately, the team of cardiologists from the Fifth Hospital of Southern Medical University was bold and careful and skillfully performed rotational atherectomy for her. This is equivalent to putting a “shield machine” on the blood vessel, opening up the life tunnel, opening the way for stent implantation, and finally successfully lifting the “life alarm” for her.
Last weekend, Granny Li, who usually suffers from coronary heart disease, suddenly suffered from chest tightness and chest pain. One attack lasted from several minutes to dozens of minutes. The family realized that something was wrong and immediately drove the old man to the local hospital. The doctor then diagnosed him as “coronary heart disease, acute non-ST-segment elevation myocardial infarction”, and performed coronary angiography, thrombus aspiration and balloon angioplasty. But after the operation, Granny Li still had chest tightness and chest pain. Later, Granny Li was sent to the Heart District 1 of the Fifth Hospital of Southern Medical University to find Director Zhou Qi.
After inquiring carefully about the situation, Zhou Qi learned that Granny Li had severe calcification of the left main coronary artery. When the local hospital considered the patient’s age and the operation was difficult, she only did simple treatment during the operation. The stent implantation could not be completed. After detailed communication with Granny Li and her family, Zhou Qi decided to perform rotational atherectomy and stent implantation for the elderly under the guidance of intravascular ultrasound (IVUS). On the day of the operation, after 4 hours, the medical team successfully completed the stent implantation in the left main trunk and anterior descending branch of Granny Li. After the operation, her symptoms of chest pain and chest tightness were significantly relieved.
Zhou Qi introduced that if elderly patients have diabetes or renal insufficiency, coronary artery calcification is relatively common, but severe calcification can only be solved by rotational atherectomy. Because the patient is old and has diabetes, the left main trunk has severe calcification, which is a great risk. During the operation, a 150,000 rpm rotational atherectomy probe can be used to abrade the stone-like plaque in the blood vessel, which is very difficult.
What is rotational atherectomy? Zhou Qi said that this is the only effective treatment method for patients with severe calcified coronary heart disease at present. Through the principle of differential cutting, the calcified lesions are polished to facilitate stent implantation. This is also a kind of pretreatment before coronary stent implantation. Just like the “shield machine” is used to open the tunnel safely and effectively in subway construction, the plaque nature is first judged under the visual technology of intravascular ultrasound. Fibrotic plaques are cut with special balloons. Severely calcified plaques cannot pass through the stent and need to be treated with rotational atherectomy. Specifically, a high-speed rotating diamond drill head is used to open the lesions, and then stents are placed to improve the success rate of interventional therapy and reduce the occurrence of complications.
Guangzhou Daily New Flower City Reporter: Zhou Jieying Correspondent: Jiang Yun
Guangzhou Daily New Flower City Editor: Weng Shuxian