冠脉病变预处理策略进展

Advances in Predilation Strategies for Coronary Lesions

摘要: 经皮冠状动脉介入治疗是冠心病治疗领域的关键手段之一，通过机械性干预恢复冠状动脉血流，尤其适用于药物治疗反应不佳或病情持续进展的患者。在这一过程中，靶病变的预处理是决定介入治疗成败的核心步骤。它不仅为后续支架的植入或药物球囊的释放创造有利条件，更直接关系到血管的长期预后和患者的临床结局。随着技术的不断发展，应用于临床的预处理技术逐渐多样化，除了球囊修饰技术外，针对钙化、支架内再狭窄等复杂病变，一系列新型技术相继应用于临床。斑块旋磨术通过高速旋转的磨头消蚀钙化斑块；轨道旋磨术则进一步优化了旋磨的操控性与安全性；而血管内碎石术利用冲击波能量安全裂解深层钙化，为严重钙化病变的处理提供了额外的选择。此外，腔内影像学技术的广泛应用是精准、成功介入治疗的重要保障之一。本文将围绕着这些技术以及相关腔内影像学进行综述，旨在为临床策略选择提供一定参考。

Abstract: Percutaneous coronary intervention (PCI) serves as one of the critical approaches in the management of coronary artery disease, restoring coronary blood flow through mechanical intervention, particularly in patients who respond inadequately to medical therapy or exhibit disease progression. During this procedure, predilation of the target lesion represents a pivotal step that significantly influences the success of the intervention. It not only creates favorable conditions for subsequent stent implantation or drug-coated balloon deployment but also directly impacts long-term vascular prognosis and clinical outcomes. With continuous technological advancements, the range of predilation techniques applied in clinical practice has become increasingly diverse. Beyond conventional balloon modification techniques, a series of novel methods have been introduced for complex lesions, such as calcified plaques and in-stent restenosis. Rotational atherectomy ablates calcified plaque using a high-speed rotating burr; orbital atherectomy further enhances maneuverability and safety; while intravascular lithotripsy safely fractures deep calcifications via shockwave energy, offering an additional option for treating severely calcified lesions. Furthermore, the widespread adoption of intravascular imaging plays an essential role in ensuring precise and successful interventions. This review focuses on these techniques and related intravascular imaging modalities, aiming to provide insights for clinical strategy selection.