光学相干断层成像指导准分子激光联合药物涂层球囊治疗复发性支架内再狭窄的初步研究  

Preliminary study of excimer laser coronary atherectomy combined with drug-coated balloon in the treatment of recurrent in-stent restenosis guided by optical coherence tomography

作　　者：王宁远 冯欢欢 王威 赖图雅 辛倩 郭军 陈韬 汪奇 高磊 WANG Ning-yuan;FENG Huan-huan;WANG Wei;LAI Tu-ya;XIN Qian;GUO Jun;CHEN Tao;WANG Qi;GAO Lei(Senior Department of Cardiology,the Sixth Medical Center of Chinese PLA General Hospital,Beijing 100048,China)

机构地区：[1]中国人民解放军总医院第六医学中心心血管病医学部,北京100048 [2]中国人民解放军总医院第一医学中心急诊科 [3]内蒙古自治区鄂尔多斯市乌审旗蒙医综合医院

出　　处：《中国介入心脏病学杂志》2023年第8期579-584,共6页Chinese Journal of Interventional Cardiology

基　　金：国家自然科学基金项目(81970443)。

摘　　要：目的观察准分子激光冠状动脉斑块消蚀术(ELCA)联合药物涂层球囊(DCB)治疗复发性支架内再狭窄(R-ISR)的安全性和有效性。方法回顾性分析2021年9月至2022年9月在中国人民解放军总医院第六医学中心心血管医学部行光学相干断层成像(OCT)辅助下ELCA联合DCB治疗的R-ISR患者9例,导丝通过病变后应用OCT评估病变特征,ELCA治疗后选择DCB处理,随后再次行OCT检查评估。观察手术成功率及并发症发生情况,随访有无主要不良心血管事件(MACE)发生。结果纳入9例患者共9处靶病变,平均年龄(64.6±12.8)岁,男8例(8/9)。所有患者均选用1.4 mm激光消蚀导管,均成功完成手术。术后未发生冠状动脉穿孔、严重夹层、冠状动脉慢血流或无复流等。随访6个月未发生MACE。1例(1/9)存在支架膨胀不全,9例(9/9)均合并新生内膜增殖,其中6例(6/9)表现为均质性,1例(1/9)为分层性,2例(2/9)为异质性,未发现钙化斑块或支架贴壁不良。术后新生内膜面积[(1.58±0.67)mm2比(3.00±1.07)mm2,P=0.002]、新生内膜负荷[(25.10±8.60)%比(58.50±19.00)%,P<0.001]均显著低于术前,差异均有统计学意义。术后最小管腔直径[(2.13±0.23)mm比(1.36±0.29)mm,P<0.001]、最小管腔面积[(4.70±0.98)mm2比(2.08±0.93)mm2,P<0.001]均显著高于术前,差异均有统计学意义。结论初步研究表明OCT指导ELCA联合DCB治疗R-ISR安全、有效。Objective To evaluate the safety and efficacy of excimer laser coronary atherectomy(ELCA)prior to drug-coated balloon(DCB)in patient with recurrent in-stent restenosis(R-ISR).Methods This retrospective study was conducted in 9 patients with R-ISR treated with ELCA prior to DCB guided by optical coherence tomography(OCT)in the Sixth Medical Center of Chinese PLA General Hospital from September 2021 to September 2022.OCT was applied to assess the lesion characteristics,and DCB was selected for management after ELCA.The success rate and complications were observed and the incidence of major adverse cardiovascular events(MACE)was observed during follow-up period.Results A total of 9 target lesions were included in 9 patients,with an average age of(64.6±12.8)years.There were 8 males(8/9).All patients selected a 1.4 mm laser ablation catheter and successfully completed the surgery.No postoperative coronary artery perforation,severe dissection,slow coronary flow,or no reflow occurred.No MACE occurred during the follow-up of 6 months.One case(1/9)had incomplete stent expansion,and all 9 cases(9/9)had neointimal proliferation.Among them,6 cases(6/9)showed homogeneity,1 case(1/9)showed stratification,and 2 case(2/9)showed mixed nature.No calcified plaques or poor stent adhesion were found.The postoperative neointimal area[(1.58±0.67)mm2 vs.(3.00±1.07)mm2,P=0.002]and neointimal load[(25.10±8.60)%vs.(58.50±19.00)%,P<0.001]were significantly lower than preoperative,with statistically significant differences.The postoperative minimum lumen diameter[(2.13±0.23)mm vs.(1.36±0.29)mm,P<0.001]and minimum lumen area[(4.70±0.98)mm2 vs.(2.08±0.93)mm2,P<0.001]were significantly higher than preoperative,with statistically significant diff erences..Conclusions ELCA prior to DCB guided by OCT is safe and eff ective in the treatment of R-ISR.

关 键 词：复发性支架内再狭窄 光学相干断层成像 准分子激光冠状动脉斑块消蚀术 药物涂层球囊 

分 类 号：R541[医药卫生—心血管疾病]