摘要
目的比较紫杉醇涂层球囊(DEB)和切割球囊治疗直径2.5 mm以下冠状动脉原发开口病变的疗效.方法采用前瞻性研究方法,入选2014年10月至2018年10月在中国医学科学院阜外深圳医院应用血管腔内成形术或切割球囊行冠状动脉原发病变介入治疗的冠心病患者66例(冠状动脉原发开口病变,所有病变参考血管直径均2.0 mm0.05).②介入治疗前DEB与切割球囊参考血管内径分别为(2.76±0.40)mm和(2.81±0.60)mm,两组比较差异无统计学意义(P>0.05);两组术前血管最小管腔直径差异无统计学意义[分别为(1.01±0.30)mm比(0.96±0.50)mm,P>0.05];两治疗组间术前直径狭窄率也无明显差异(P>0.05).③DEB组患者住院期间未发生主要不良心血管事件;切割球囊组1例患者在术后当天因对角支靶病变D型夹层累计前降支主干,行前降支补救性支架置入后好转.④两组患者前期血管造影:两组术后即刻最小管腔直径[(2.42±0.38)mm比(2.33±0.41)mm]、直径狭窄率[(15.60±7.82)%比(16.30±8.10)%],差异无统计学意义(P>0.05).⑤9~12月随访,相比于切割球囊组,DEB组的段内分析的最小管腔直径更大[(1.97±0.75)mm比(1.78±0.73)mm,P<0.05],且直径狭窄百分数更低[(18.8±16.0)%比(25.2±19.0)%,P<0.01];DEB组靶病变再狭窄发生率更低(6.1%比15.2%,P<0.05),血管造影晚期管腔丢失平均值更小[(0.34±0.04)mm比(0.46±0.05)mm,P<0.05],随访期间两组再发心绞痛差异无统计学意义(9.1%比15.1%,P>0.05);切割球囊组有1例发生急性心肌梗死,两组患者均无死亡.结论在小血管原位开口病变患者中,药物球囊和切割球囊处理均得到良好的介入效果,相比于切割球囊,药物球囊治疗小血管原位开口病变的晚期血管造影结果更优.
Objective To compare the efficacy of drug-eluting balloon versus cutting balloon in patients with primary coronary stenosis of small vessel.Methods The immediate and follow-up angiographic outcomes of 66 patients with primary coronary stenosis of small vessel who were treated by DEB and cutting balloon were analyzed in this prospective study.The primary endpoint was the MACE rate,minimal lumen diameter and recurrent restenosis rate at 9-12 months follow-up.Results Procedural success was achieved in all patients.(1)There was no significant difference in age,diabetes,hypertension and hypercholesterolemia between the two groups(P>0.05).(2)There was no significant difference between the two groups(P>0.05);there was no significant difference between the two groups 1.01±0.30)mm vs.(0.96±0.50)mm,P>0.05 there was no significant difference between the two groups(P>0.05).(3)No major adverse cardiovascular events occurred during hospitalization in DEB group;one patient in cutting balloon group accumulated anterior descending trunk on the day after operation due to D-type dissection of diagonal target lesion and improved after anterior descending remedial stent implantation.(4)There was no significant difference between the two groups(P>0.05).(5)During the 9-12 months follow-up,compared with the balloon cutting group,the smallest lumen diameter in the DEB group was larger(1.97±0.75)mm vs.(1.78±0.73)mm,P<0.05 and the percentage of diameter stenosis was lowerL(18.8±16.0)%vs.(25.2±19.0)%,P<0.01;the incidence of target lesion restenosis in the DEB group was lower(6.1%vs.15.2%,P<0.05)and the average value of lumen loss in the late stage of angiography was smaller(0.34±0.04)mm.There was no significant difference between the two groups during the follow-up period(9.1%vs.15.1%,P>0.05);one case of acute myocardial infarction occurred in the cutting balloon group and there was no death in both groups.Conclusion In patients with stenosis of small vessel,both DEB and cutting balloon provided excellent clinical results with a very low rate of clinical and angiographic recurrences.Compared with cutting balloon,DEB provide superior late angiographic findings.
作者
何松坚
翁建新
孙帅
刘强
李华秋
陈俊求
徐帅
曹茜
魏熠
唐文辉
HE Song-jian;WENG Jian-xin;SUN Shuai;LIU Qiang;Li Hua-qiu;CHEN Jun-qiu;XU Shuai;CAO Qian;WEI Yi;TANG Wen-hui(Department of Cardiovascular Medicine,Shenzhen Sun Yat-sen Cardiovascular Hospital,Shenzhen 518020,China)
出处
《中国心血管病研究》
CAS
2020年第7期611-616,共6页
Chinese Journal of Cardiovascular Research
基金
深圳市科技计划项目(JCYJ20160427174723796)。
关键词
药物洗脱球囊
切割球囊
小血管
经皮状动脉介入治疗
Drug-eluting balloon
Cutting balloon
Small vessel
Percutaneous coronary intervention
