经皮冠状动脉腔内切割球囊成形术的临床应用

Immediate and Intermediate Outcomes of Percutaneous Transluminal Coronary Cutting Balloon Angioplasty

目的 评价经皮冠状动脉腔内切割球囊成形术 (CBA)治疗初治病变和支架内再狭窄的疗效。 方法 35例冠心病病人 (初治病人 7例 ,支架内再狭窄病人 2 8例 )施行CBA。左前降支病变 2 5处 ,左回旋支病变 10处 ,右冠病变 7处。初治病变平均狭窄 (85 9± 7 2 ) % ,支架内再狭窄的平均狭窄程度是 (89 6± 8 9) %。CBA后即刻行冠脉造影评价近期手术成功率 ,随后严格的临床随访每个月 2次 ,共 6个月 ,以评价中期疗效。 结果 共使用切割球囊 4 2个 ,直径 (3 2± 0 3)mm(3 0～ 3 75mm) ,长度 10～ 15mm ,扩张压力 (72 7± 6 0 )kPa(6 0 6～ 10 10kPa) ,扩张次数 (5 0± 2 1)次 (4～ 7次 ) ,扩张时间 (2 0 3 6± 90 8)s。CBA近期手术成功率 10 0 % ,无严重冠脉闭塞等并发症。术前病变的狭窄程度为 (89 6± 8 9) % ,术后残余狭窄为 (8 8± 3 7) % (P <0 0 1)。 6个月随访未发现心绞痛复发 ,心电图和超声心动图无心肌缺血加重的证据。 结论 切割球囊不论对初治还是冠状动脉支架内再狭窄的病人 ,都是安全有效的介入治疗方法 ,其近期手术成功率高 ,中期的临床疗效确切。

Objective To assess the outcomes of percutaneous transluminal coronary cutting balloon angioplasty(CBA) in the treatment of de novo lesions and in-stent restenosis. Methods Seven de novo lesions and 28 in-stent restenosis in 35 patients with coronary disease[23 males, 12 females, aged (50.6±7.8) years] underwent CBA. Twenty-five lesions located at left anterior descending artery, 10 at left circumflex artery and 7 at right coronary artery. The average percent diameter stenosis rate in de novo lesions was (85.9±7.2)%, which in in-stent restenosis was (89.6±8.9)%. Coronary angiography was performed immediately after the procedure for evaluation of immediate success and the clinical follow-up was done twice a month for 6 months for assessment of intermediate outcomes. Results Forty-two cutting balloons with the mean diameter of (3.2±0.3)mm (3.0～3.75 mm) and the length of 10～15 mm were employed during the procedures. The mean inflation pressure was (727±60)kPa (606～1010 kPa) with the mean inflation time of (5.0±2.1) and the mean inflation duration of (203.6±90.8)s. The immediate technical success rate for CBA was 100% without any severe complications including severe coronary dissection. The average percent diameter stenosis rats was (8.8±3.7)% after this procedures. During the 6 month follow-up, no recurrent angina was found clinically and no myocardial ischemia was documented by either ECG or echocardiography. Conclusion CBA is efficacious and safe for angioplasty of de novo lesions and in-stent restenosis with high immediate and intermediate success.