药物涂层球囊对冠状动脉左主干分叉病变治疗的临床研究  

Efficacy of Drug Coated Balloon for the Treatment of Unprotected Left Main Bifurcation Lesions

作　　者：李蒙[1] 张燕[1] 陈岩[1] 安松涛[1] 刘军[1] 张建红[1] 孟华[1] 李文博 刘磊[2] LI Meng;ZHANG Yan;CHEN Yan;AN Songtao;LIU Jun;ZHANG Jianhong;MENG Hua;LI Wenbo;LIU Lei(Heart Center of Henan Provincial People's Hospital,Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou(450003),Henan,China)

机构地区：[1]河南省人民医院心脏中心华中阜外医院郑州大学华中阜外医院,河南省郑州市450003 [2]郑州人民医院

出　　处：《中国循环杂志》2019年第11期1062-1067,共6页Chinese Circulation Journal

基　　金：河南省科技攻关项目(162102310034)

摘　　要：目的:探究冠状动脉(冠脉)左主干分叉病变中应用药物涂层球囊(DCB)的即刻效果和临床随访情况。方法:回顾性分析168例冠脉左主干分叉病变行介入治疗患者资料,根据介入策略将其分为单纯球囊扩张组66例(左主干-左前降支置入支架,左回旋支行球囊扩张)、双支架组58例(左主干-左前降支、左回旋支均置入支架)和药物球囊组44例(左主干-左前降支置入支架,左回旋支行药物球囊扩张),分析术后即刻、术后1年内随访的介入手术资料及术后1年内主要不良心脏事件,包括心绞痛、心肌梗死、心原性死亡、支架内再狭窄、靶病变重建及支架内血栓形成的情况。结果:(1)三组间临床基线资料差异无统计学意义(;2)双支架组左回旋支术中支架直径及术后即刻开口直径稍大于药物球囊组的球囊直径和术后即刻开口直径,但差异无统计学意义,两者均大于单纯球囊扩张组(P<0.05);左回旋支术后即刻开口狭窄,双支架组小于药物球囊组,但差异无统计学意义,两者均小于单纯球囊扩张组(P<0.05);(3)血管内超声指导患者中,在术后即刻左回旋支开口面积上双支架组大于药物球囊组,但差异无统计学意义,两者均大于单纯球囊扩张组(P<0.05);(4)术后1年内,左回旋支开口管腔直径方面,双支架组与药物球囊组均大于单纯球囊扩张组(P<0.05);左回旋支开口残余狭窄方面,双支架组与药物球囊组均小于单纯球囊扩张组(P<0.05);左回旋支开口管腔丢失方面,单纯球囊扩张组>双支架组>药物球囊组(P<0.05);在总的支架内再狭窄方面,药物球囊组优于双支架组(P<0.05);(5)术后1年内单纯球囊扩张组心绞痛发病率高于双支架组及药物球囊组(P<0.05)。结论:药物球囊组术后即刻及术后随访优于单纯球囊扩张组,不劣于双支架组,可作为左主干分叉病变一种术式选择。Objectives:To investigate the immediate effect and outcome during one year clinical follow-up of drug-coated balloon for patients with bifurcation lesions of left main coronary artery.Methods:The clinical data of 168 patients with bifurcation lesions of left main coronary artery undergoing interventional therapy were retrospectively analyzed.According to interventional strategy,patients were divided into simple balloon dilatation group(n=66),double stent group(n=58)and drug coated balloon group(n=44).The main adverse cardiac events(including angina pectoris,myocardial infarction,sudden cardiac death,in-stent restenosis,target lesion reconstruction and stent thrombosis)during hospitalization and one year after procedure were analyzed.Results:(1)There was no significant difference in clinical baseline data among the three groups.(2)The diameter of stent(or balloon)in LCX and the diameter of immediate opening in LCX after procedure tended to be larger in double stent group compared to drug coated balloon group(P>0.05),the diameter of both group was significantly larger than those of isolated balloon dilation group(P<0.05).The incision of LCX was narrowed immediately after procedure,and tended to be smaller in the double stent group than in the drug coated balloon group(P>0.05),were significantly smaller in both groups than in the isolated balloon dilation group(P<0.05).(3)In IVUS-guided procedures,the open area of LCX tended to be larger in the double stent group than in drug coated balloon group(P>0.05),were significantly larger in both groups than in balloon dilatation group(P<0.05).(4)Within one year after procedure,the diameter of the open lumen of LCX in the double stent group was the same as that in the drug coated balloon group,which was significantly larger than in the balloon dilatation group(P<0.05).The residual stenosis rate of LCX in double stent group was similar to that in drug coated balloon group,which was lower than that in isolated balloon dilation group(P<0.05).Loss of open lumen of LCX was signif

关 键 词：药物涂层球囊 左主干病变 分叉病变 血管内超声 

分 类 号：R541[医药卫生—心血管疾病]