血管内超声、切割球囊和非顺应性球囊在支架内再狭窄中的应用

The Use of IVUS Cutting Balloon and Non-compliant Balloon in in-stent Restenosis

目的 :应用血管内超声 (IVUS)探讨支架内再狭窄的机制 ,研究切割球囊及非顺应性高压球囊治疗支架内再狭窄的近远期疗效。方法 :48例患者 ,5 6支病变冠脉 ,64处病变 ,血管内超声检测显示内膜增生为主者 48处予切割球囊扩张 ,显示为原支架扩张不充分伴内膜增生者 16处予非顺应性高压球囊扩张 ,术后平均 5 3月行冠脉造影随访。结果 :血管内超声显示内膜增生为支架内再狭窄的主要因素的患者 (66 7% )采用切割球囊扩张 ,扩张前后支架内增生内膜的面积缩小 (P <0 0 5 ) ,支架截面积变化不大 (P >0 0 5 ) ;血管内超声显示原支架扩张不充分伴内膜增生的患者则予非顺应性高压球囊扩张 ,扩张前后支架截面积增加 (P <0 0 5 ) ;同时支架内增生内膜面积减小 (P <0 0 5 )。冠脉造影随访 ,切割球囊组和非顺应性球囊组再次支架内狭窄发生率分别为 2 8 6%、2 9 7% (P >0 0 5 )。结论 :结合应用血管内超声 ,切割球囊和非顺应性球囊可以在支架内再狭窄的治疗中取得更佳疗效 。

Objectve:To study the efficacy of IVUS(intravascular ultrasound)and to evaluate the immediate and long term clinical outcome of cutting balloon?non compliant balloon in coronary in stent retenosis.Method:Fourty eight patients with 56 stenotic coronary arteries and 64 lesions enrolled the study.The study patients were classified into two groups by IVUS.Group 1 was treated by cutting balloon while group 2 by non compliant balloon.Coronary angiography was carried out at the average of 5.3 months after the procedure.Results:IVUS revealed that 48 lesions(group 1,66.7% of all lesions)were dominantly caused by intimal hyperplasia while the rest (group 2)by suboptimal dilataion of the stent.In group 1,cutting balloon(CB)was used to dilate the lesions,the post CB intimal hyperplasia(IH)cross sectional areas(CSA)was significantly smaller than pre CH IH CSA( P <0 05),however,there were no obvious changes in stent CSA( P >0 05) Non compliant balloon was used in group 2,there were significant increase in stent CSA( P <0 05)as well as significant decrease in IH CSA( P <0 05).Coronary angiographic follow up showed target lesion restenosis in group1 and group 2 was 28.6%?29.7% respectively( P >0 05).Conclusion:This series demonstrates that the combination of IVUS?cutting balloon and non compliant balloon is a useful strategy for the treatment of in stent restenosis.