药物洗脱支架联合药物涂层球囊处理冠状动脉分叉病变的研究  

Study on drug-eluting stent combined with drug-coated balloon in the treatment of bifurcation coronary artery lesions

作　　者：张欣欣[1] 杨永忠[1] 张艳玲[1] 沈青青 张磊[1] 刘伟[1] 杨超[1] 李彦[1] 高振华[1] ZHANG Xinxin;YANG Yongzhong;ZHANG Yanling;SHEN Qingqing;ZHANG Lei;LIU Wei;YANG Chao;LI Yan;GAO Zhenhua(Handan Central Hospital,Handan 056001,Hebei,China;Xingtai Third Hospital,Xingtai 054000,Hebei,China)

机构地区：[1]邯郸市中心医院,河北邯郸056001 [2]邢台市第三医院,河北邢台054000

出　　处：《现代中西医结合杂志》2021年第32期3570-3575,共6页Modern Journal of Integrated Traditional Chinese and Western Medicine

基　　金：河北省卫生健康委科研基金课题(20191836)。

摘　　要：目的探讨按必要时边支支架术原则处理冠状动脉(冠脉)真性分叉病变时,在主支植入药物洗脱支架(DES)、分支应用药物涂层球囊的安全性及可行性。方法纳入2016年1月—2018年12月在邯郸市中心医院经冠脉造影证实的真性分叉病变患者(Medina分型属于1,1,1;1,0,1;0,1,1),在主支植入DES,成功对吻扩张后,将患者按1∶1比例随机分配到普通球囊组(50例)和药物涂层球囊组(50例)。记录2组术前、术后即刻定量冠状动脉造影结果,并于术后9个月复查冠脉造影。主要疗效终点是9个月时的分支血管晚期管腔丢失(LLL),次要疗效和安全终点包括血管靶病变的最小管腔直径(MLD)、管腔狭窄率(DS)和主要不良心血管事件(MACE)。结果2组患者均有50处分叉病变接受干预。术后9个月普通球囊组有42例、药物涂层球囊组有43例患者复查了冠脉造影。2组患者主支血管的LLL、MLD、DS比较差异均无统计学意义(P均>0.05)。普通球囊组分支血管LLL多于药物涂层球囊组(P<0.05),MLD小于药物涂层球囊组(P<0.05),DS大于药物涂层球囊组(P<0.05)。住院期间普通球囊组1例患者发生急性支架内血栓形成,1例患者术后6个月因心绞痛在分支血管进行介入干预。药物涂层球囊组1例患者因心绞痛症状在术后4个月行血管重建。9个月时复查冠状动脉造影2组均无行血管重建者,随访期间2组均无患者死亡。结论按必要时边支支架术处理冠脉真性分叉病变时,联合药物涂层球囊处理分支血管较普通球囊安全、可行,9个月时分支血管有更好的造影结果,LLL更少。主支血管植入DES,联合应用药物涂层球囊处理分叉病变可作为治疗冠脉真性分叉病变的一种安全、有效的手段。Objective It is to explore the safety and feasibility of implanting a drug-eluting stent(DES)in the main branch and applying a drug-coated balloon(DCB)to the sub-branch when treating true coronary bifurcation lesions according to the principle of side branch stenting when necessary.Methods The patients with true bifurcation lesions confirmed(Medina type:1,1,1;1,0,1;0,1,1)by coronary angiography in Handan Central Hospital from January 2016 to December 2018 were recruited.After DES was implanted in the main branch and successful kissing balloon inflation,the patients were randomly assigned to the ordinary balloon group(n=50)and the drug-coated balloon group(n=50)at a ratio of 1∶1.Preoperative and postoperative quantitative coronary angiography results were recorded in the two groups,and coronary angiography was rechecked in 9 months after the operation.The primary outcome was late lumen loss(LLL)of side branch at 9 months.Secondary outcomes and safety endpoints included minimum luminal diameter(MLD)for target vascular lesions,luminal stenosis rate(DS),and major adverse cardiovascular events(MACE).Results Fifty bifurcation lesions were treated in both groups.At 9 months after surgery,42 patients in the ordinary balloon group and 43 patients in the drug-coated balloon group underwent coronary angiography.There was no significant difference in LLL,MLD and DS of the main vessels between the two groups(P>0.05).The LLL of sub-branch in the ordinary balloon group was more than that of drug-coated balloon group(P<0.05),the MLD was smaller than that of drug-coated balloon group(P<0.05),and DS was greater than that of drug-coated balloon group(P<0.05).During hospitalization,1 patient in the ordinary balloon group developed acute stent thrombosis,and 1 patient underwent intervention for angina pectoris in side branch vessel 6 months after surgery.1 patient in the drug-coated balloon group underwent vascular reconstruction 4 months after operation due to angina pectoris.No patients in the 2 groups underwent vascular reconstr

关 键 词：药物涂层球囊 分叉病变 冠心病 药物洗脱支架 

分 类 号：R543.3[医药卫生—心血管疾病]