摘要
目的 比较采用普通球囊（Ballon）、药物涂层球囊（DCB）和药物洗脱支架（DES）等三种方案治疗经皮冠状动脉介入治疗（PCI）术后支架内再狭窄（ISR）的临床效果.方法 选取南京市第二医院心内科2014年8月至2018年1月经冠状动脉造影确诊的ISR患者95例为研究对象,分别采用Ballon、DCB或第二代DES再次植入治疗,根据所接受的治疗不同将患者分别纳入Ballon组（47例）、DCB组（25例）和DES组（23例）.术后6～12个月复查,比较三组支架内靶病变节段晚期管腔丢失（LLL）、最小管腔直径（MLD）以及再狭窄率.术后6～12个月随访,记录三组患者随访6～12个月内主要不良心血管事件（MACE）发生率.结果 术后6～12个月后复查造影,DCB组MLD显著大于Ballon及DES组[（1.86±0.27）mm比（2.16±0.43）mm,t=3.57,P=0.00;（1.94±0.31）mm比（2.16±0.43）mm,t=2.05,P=0.05];DCB组再狭窄率显著低于Ballon及DES组[15例（31.91％）比2例（8.69％）,χ2=4.53,P=0.02;8例（32.00％）比2例（8.69％）,χ2=2.66,P=0.05];DCB组LLL显著低于Ballon及DES组[（0.67±0.28）mm比（0.21±0.18）mm,t=7.17,P=0.00;（0.43±0.28）mm比（0.21±0.18）mm,t=3.21,P=0.00];DCB组MACE显著低于Ballon及DES组[16例（34.04％）比1例（4.76％）,χ2=7.02,P=0.01;8例（32.00％）比1例（4.76％）,χ2=4.06,P=0.02].结论 DCB扩张治疗ISR较Ballon扩张及再次植入DES具有更好的有效性及安全性.
Objective To compare the clinical effect of three methods of treatment for the in-stent restenosis（ISR）after percutaneous coronary intervention（PCI）,drug coated balloon（DCB）compared with common balloon and drug eluting stent（DES）.Methods From August 2014 to January 2018,95 cases of ISR in the Second Affiliated Hospital of Southeast University were diagnosed by coronary angiography.They were treated with common balloon,DCB or second generation DES.The patients were assigned to the DCB group 25 cases or the second-generation DES group（23 cases）and balloon group（47 cases）according to the therapeutic strategies they accepted.Major adverse cardiac events（MACE）of patients were followed by telephone or hospital visit at 6-12 months.MACE was defined as a composite of cardiac death,nonfatal myocardial infarction（MI）,and target vessel revascularization（TVR）.Results In summary,95 patients with DES-ISR were enrolled,including 47 patients in the balloon group,23 patients in the DCB group and 25 patients in the second-generation DES group.Coronary angiography was performed 6-12 months after operation.The minimum lumen diameter（MLD）of the DCB group was significantly larger than those of the balloon and DES groups[（1.86 ±0.27）mm vs.（2.16 ±0.43）mm,t =3.57,P =0.00;（1.94 ±0.31）mm vs.（2.16 ± 0.43）mm,t=2.05,P=0.05].The restenosis rate of the DCB group was significantly lower than those of the balloon group and DES group[15 cases（31.91%）vs.2 cases（8.69%）,χ2 =4.53,P=0.02;8 cases（32.00%）vs.2 cases（8.69%）,χ2 =2.66,P=0.05].The rate of late lumen loss（LLL）in the DCB group was significantly lower than those of balloon group and DES group [（0.67 ±0.28）mm vs.（0.21 ±0.18）mm,t =7.17,P =0.00;（0.43 ± 0.28）mm vs.（0.21 ±0.18）mm,t=3.21,P=0.00].MACE was significantly lower than balloon group and DES group[16 cases（34.04%）vs.1 cases（4.76%）,χ2 =7.02,P=0.01;8 cases（32.00%）vs.1 cases（4.76%）,χ2 =4.06,P=0.02].Conclusion Drug balloon dilatation in stent restenosis is more effective and safer than common balloon dilatation and re-implantation of drug eluting stents.
作者
郭忠玉
朱铁兵
Guo Zhongyu;Zhu Tiebing(Department of Cardiology,the Second Hospital of Nanjing,Nanjing,Jiangsu 210003,China;Department of Cardiology,the People＇s Hospital of Jiangsu Province,Nanjing,Jiangsu 210003,China)
出处
《中国基层医药》
CAS
2018年第19期2493-2496,共4页
Chinese Journal of Primary Medicine and Pharmacy
关键词
冠状动脉再狭窄
药物洗脱支架
药物涂层球囊
管腔丢失
Coronary restenosis
Drug-eluting stents
Drug-coated balloon
Minimum lumen diameter
Late lumen loss
