切割球囊成形术与经皮腔内β-射线放射疗法联合治疗冠状动脉支架内再狭窄

Intracoronary beta radiation combined with cutting balloon angioplasty for treatment of in-stent restenosis

目的 观察切割球囊成形术 (CBA)与经皮冠状动脉 (冠脉 )内 β 射线放射疗法 (β 放疗 )联合治疗支架内再狭窄 (ISR)的疗效及其安全性。方法 冠脉内支架置入术后ISR >70 %的患者2 95例 ,男性 2 0 5例 ,女性 90例 ,平均年龄 (5 9 76± 10 83)岁 ,其中 112例均行CBA联合 β 放疗作为β 放疗组 (n =112 ) ,183例单独采用CBA(89例 )或普通球囊扩张成形术 (94例 )为对照组 (n =183)。弥漫性长病变ISR者回撤 β 放疗导管分段照射。所有患者术前、术后即刻及术后随访期行冠脉造影 ,随访靶血管血运重建 (TVR)和主要不良心血管事件 (MACE)发生率。结果 两组患者的术前及术后即刻冠脉造影结果差异无显著性。随访期 (6 3± 1 6 )月 β 放疗组的最小管腔直径大于对照组 ,管腔直径狭窄百分比小于对照组 ,P <0 0 5。β 放疗组与对照组的心绞痛、心肌梗死及病死率相似(心绞痛为 10 %比 17% ,心肌梗死为 1%比 2 % ,病死率为 0 %比 2 % ) ,但 β 放疗组的TVR和MACE明显低于对照组 (TVR为 5 %比 16 % ,MACE为 11%比 2 1% ,P <0 0 5 )。β 放疗组 2 8例 (2 5 % )弥漫性长病变ISR ,分段照射后随访TVR和MACE无增加。结论 冠脉内 β 放疗和CBA相结合治疗ISR安全、有效 ,TVR和MACE明显降低。采用回撤 β 放疗导管?

Objective To evaluate the effectiveness and safety of intracoronary beta(β)radiation with cutting balloon angioplasty(CBA) and pullback intracoronary radiation in the patients with in-stent restenosis (ISR). Methods Two hundred and ninety five patients(male 205, female 90,mean age 59.76±10.83 years) who admitted hospital because of chest pain syndromes and had angiographically documented ISR of native coronary vessels (>70%) were involved in this study. Patients were assigned as intracoronary β-radiation (Beta Cath 30 mm or 40 mm system, Novoste) with CBA group ( n =112) and control group ( n =183). Pullback radiation was performed for long ISR lesions. In control group, patients received routine PTCA or CBA alone. In both groups, Quantitative coronary angiography was performed, and target vessel revascularization (TVR) and major adverse cardiovascular events (MACE) were documented. Results Clinical follow-up (6.3±1.6 months) was obtained in 106 patients (95%) in the intracoronary β-radiation with CBA group and 172 patients (94%) in the control group. At follow-up, in the intracoronary β-radiation with CBA group, MLD was larger and DS was lower than that in the control group respectively. Both TVR and MACE occurred significantly less in the intracoronary β-radiation with CBA group than those in the control group (5% vs 16% for TVR, and 11% vs 21% for MACE; P <0.05 for both). No increase of TVR and MACE was found in the patients with pullback radiation. Conclusion Intracoronary β-radiation combined with CBA for ISR seems to yield low rates of TVR and MACE. Pullback radiation using the Beta Cath 30 mm or 40mm system was safe and could be used to treat long ISR lesions effectively.