紫杉醇药物涂层球囊扩张冠状动脉支架内再狭窄病变增加远期管腔面积  

Long-term lumen area enlarged in coronary in-stent restenosis after the treatment of paclitaxel drug-coated balloon dilatation

作　　者：刘蓉[1] 马士新[1] 赵钢[1] 杭靖宇[1] 魏盟[1] 陆志刚[1] 

机构地区：[1]上海交通大学附属第六人民医院心内科,200233

出　　处：《介入放射学杂志》2017年第4期367-369,共3页Journal of Interventional Radiology

摘　　要：目的探讨以单纯紫杉醇药物涂层球囊(DCB)扩张冠状动脉介入治疗术后支架内再狭窄(ISR)病变段,观察远期靶血管管腔面积,从而证实DCB在ISR病变中的作用。方法选取4例符合DCB适应证ISR患者,按照标准流程在充分预扩张基础上予以紫杉醇DCB扩张病变段,不植入支架。术后即刻及术后9个月采用冠状动脉造影和血管内超声检测患者最小管腔横截面积(MLA)、支架横截面积(SA)和血管内膜增生状况。结果 4例患者单纯紫杉醇DCB治疗后即刻造影显示靶血管扩张段无夹层,无明显残余狭窄。术后9个月造影显示所有患者靶血管扩张段管腔通畅,病变段未见明显再狭窄,TIMI血流3级;血管内超声检测显示MLA均较术后即刻显著增加,SA呈增加趋势,内膜增生呈抑制趋势。结论单纯DCB扩张ISR病变可增加远期管腔面积,避免二次支架植入,降低再次ISR风险,并通过局部释放紫杉醇作用于管壁,抑制内膜过度增生。Objective To investigate the effect of paclitaxel drug-coated balloon （DCB） dilatation in treating coronary in-stent restenosis （ISR） occurring after drug-eluting stent （DES） implantation, and to observe the long-term changes of the target vascular lumen area in order to clarify the curative effect of paclitaxel DCB in treating ISR. Methods Four patients with ISR whose clinical condition met the DCB indication were selected. According to the standard process, sufficient pre-expansion of ISR was performed first, then paclitaxel DCB dilatation was carried out to dilate the lesion segment of ISR, and no stent was implanted. Both coronary angiography and intravascular ultrasound （IVUS） were performed immediately after the treatment as well as 9 months to measure the minimum lumen area （MLA） and cross-sectional area （SA） of the stent, and the intimal hyperplasia was also been evaluated. Results In all 4 patients, angiography performed immediately after paclitaxel DCB dilatation showed that neither dissection of the dilated segment of the target artery nor obvious residual stenosis was observed. Angiography performed 9 months after the treatment revealed that all dilated segments of the target arteries were patent, and no pronounced restenosis of stent segment was seen. IVUS examination was indicated that MLA became enlarged, SA showed an increasing trend, and intimal hyperplasia showed a tendency to be inhibited. Conclusion For the treatment of ISR, pure paclitaxel DCB dilatation can obtain long-term lumen area enlargement, thus, repeated stent implantation can be avoided, which, in turn, can reduce the risk of ISR recurrence. Paclitaxel DCB dilatation can locally release paclitaxel, which has curative effect on the coronary artery wall to inhibit the excessive proliferation of intima.

关 键 词：药物涂层球囊 支架内再狭窄 远期管腔面积扩张 

分 类 号：R543.3[医药卫生—心血管疾病]