紫杉醇涂层球囊与第二代药物洗脱支架治疗支架内再狭窄患者的临床分析  

Treatment of in-stent restenosis with paclitaxel-coated balloon and second generation drug eluting stent

作　　者：孙美珠 刘宏斌[2] 黄党生[1] 于茜[2] 肖湖南 Sun Meizhu;Liu Hongbin;Huang Dangsheng;Yu Qian;Xiao Hunan(Department of Cardiovascular Medicine,First Affiliated Hospital of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]解放军总医院第一附属医院心血管内科,北京100048 [2]解放军总医院南楼心血管内科,北京100048

出　　处：《中国循证心血管医学杂志》2018年第9期1095-1098,共4页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的比较药物洗脱支架(DES)再置入与药物涂层球囊(DCB)扩张治疗药物洗脱支架内再狭窄(IRS)的安全性和疗效。方法选取于2015年8月～2017年3月于解放军总医院心血管内科就诊的DES治疗的IRS患者共171例,分别接受紫杉醇涂层球囊(PCB)治疗(PCB group,n=75)和第二代DES(G2-DES)治疗(G2-DES group,n=96),对两组临床基线特征及冠脉造影结果进行分析,并随访一年后冠状动脉(冠脉)造影(CAG)资料(病变血管、支架特征、平均扩张压、扩张时间、支架内与节段内再狭窄率、最小管腔支架等)及主要不良心血管事件(MACE,晚期管腔丢失、二次再狭窄率、全因死亡、ST段抬高型心肌梗死、靶血管血运重建)。结果两组患者基线资料及术前冠脉造影结果无统计学差异(P>0.05)。两组患者进行经皮冠状动脉介入治疗(PCI)在使用器械上(支架长度、直径)无统计学差异(P>0.05)。PCI后,PCB组的平均扩张压力更低(P<0.001),扩张时间更长(P<0.001),另外PCI后,PCB组支架内管腔狭窄率更高(P=0.001),支架内最小管腔直径更低(P=0.035);且术后节段内管腔狭窄率更高(P=0.002),但是节段内最小管腔直径无统计学差异(P=0.086)。随访分析发现两组患者的CAG特征及MACE上无统计学差异(P>0.05)。结论紫杉醇药物涂层球囊治疗IRS安全有效,与第二代DES治疗IRS无显著差异。Objective To compare the safety and curative effects of re-implantation of drug eluting stent(DES)and dilation of drug-coated balloon(DCB)in treatment of in-stent restenosis(IRS).Methods IRS patients(n=171)were chosen from Department of Cardiovascular Medicine of the First Affiliated Hospital of Chinese PLA General Hospital from Aug.2015 to Mar.2017,and received respectively paclitaxel-coated balloon treatment(PCB group,n=75)and second generation DES(G2-DES group,n=96).The clinical baseline features and results of coronary angiography(CAG)were analyzed in 2 groups.The data of CAG[diseased vessels,stent features,mean diastolic pressure(MDP),diastolic time,restenosis rates in stent and segment and minimal lumen stent]and major adverse cardiovascular events[MACE,late lumen loss,secondary restenosis rate,all-cause mortality,ST-segment elevation myocardial infarction(STEMI)and target vessel revascularization(TVR)]were followed up for 1 y.Results The baseline data and results of preoperative CAG had no statistical difference between 2 groups(P>0.05).There was no statistical difference in therapeutic apparatus(length and diameter of stent)during PCI between 2 groups(P>0.05).After PCI,MDP was lower(P<0.001),diastolic time was longer(P<0.001),in-stent lumen stenosis rate was higher(P=0.001)and in-stent minimal lumen diameter was lower(P=0.035)in PCB group.And in-segment lumen stenosis rate was higher(P=0.002)and in-segment minimal lumen diameter had no statistical difference(P=0.086).The follow-up results showed that CAG features and MACE had no statistical difference between 2 groups(P>0.05).Conclusion PCB is safe and effective in treatment of IRS,and it has no significant difference compared with G2-DES.

关 键 词：支架内再狭窄 紫杉醇药物球囊 药物洗脱支架 

分 类 号：R816.2[医药卫生—放射医学]