球囊预扩张对冠状动脉支架置入操作的影响

Effect of predilation on implantation procedure of coronary stenting

目的 观察球囊预扩张效果对支架置入操作的影响。方法 将内径≥ 3 0mm的前降支开口以远病变 (长度≤ 2 0mm、狭窄 80 %～ 99%、中度以下钙化、TIMIⅡ～Ⅲ级、近端弯曲≤ 45°)随机分为 2 0mm、2 5mm和 3 0mm球囊预扩张组 ,采用同一品牌的指引导管、导丝和球囊导管进行预扩张 ,观察球囊充盈程度、球囊通过病变率、TIMI血流率和夹层发生率。对达到支架样扩张效果者结束操作 ,其他病变均置入相同品牌的预装混合支架并观察 :支架到位率、球囊充盈程度、近端血管直径与球囊直径、残余狭窄程度、TIMI改善率。结果 共入选病人 5 0例 (男 36、女 14) ,年龄 6 7 8± 15 3(4 2～87)岁。前降支病变特点 :长度 16 4± 8 3(5～ 2 4)mm ,狭窄程度 94 1± 5 2 (80～ 99) % ,TIMI 1 6± 0 7(1～ 2 )。三组病人年龄、病变长度、狭窄程度和TIMI等参数具有可比性 (P <0 0 5 )。预扩张后 ,3 0mm球囊组 2例达到支架样扩张效果 ,退出观察。各组预扩张压力和时间无显著差异 (P >0 0 5 )。与 2 5mm以上球囊组相比 ,2 0mm球囊组预扩张后TIMI改善率低、支架不能通过病变率高 (P >0 0 5 )。与2 5mm以下球囊组相比 ,3 0mm球囊组的TIMI改善率、支架通过率虽然较高 ,但血管夹层的发生率亦明显增加 (P <0 0 5 )。

Objective To evaluate the effect of pre dilation with different balloon on the coronary stenting procedure Methods Lesions of Left anterior descending artery (LAD, dimension ≥3 0 mm with length 20 mm, 80%～99% stenosis, middle degree calcification, Ⅱ～Ⅲ TIMI and paroxysmal tortuous ≤45°) were randomized into 2 0 mm, 2 5 mm and 3 0 mm balloon dilation groups Guiding catheter, wire and balloon catheter from the same company were used If stent like effect was not achieved after pre dilation, a suitable stent was implanted Parameters of stent pass rate, dissection rate, residual stenosis and TIMI flow were compared in above three groups Results Fifty patients with male 36, female 14, 67 8±15 3 (42～87) years old were randomized LAD lesion had its length of 16 4±8 3 (5～24)mm,stenosis degree of 94 1±5 2 (80～99)% and TIMI 1 6±0 7 (1～2) The parameters of patient aging, lesion length and stenosis degree were comparable in all 3 groups ( P >0 05) After pre dilation, two cases having the effect of stent like in 3 0 mm balloon group were out from the study The dilation pressure and time between each of 3 groups were similar ( P >0 05) Comparing to the groups using balloon above 2 5 mm, the TIMI rising rate and stent passing rate of 2 0 mm balloon group were low ( P <0 05) Comparing to the groups using balloon below 2 5 mm, although the TIMI rising rate and stent passing rate of 3 0 mm balloon group were very high, the dissection rate also increased significantly ( P <0 05) Making comprehensive analysis from 3 groups, it was found that to the coronary with inner diameter of 3 0 mm, the low dissection rate, high stent position rate and acceptable TIMI change rate could be achieved if a 2 5 mm balloon is used Conclusion If the stent like effect is not considered, it is better to select a pre dilation balloon which has a diameter of 10%～20% smaller than the inner diameter of lesion coronary to achive the effect of better pre dilation, easier stent position and less new vessel dissection