切割球囊和血管内放射治疗支架内再狭窄的近期疗效观察

Short-term results of cutting balloon and intravascular brachytherapy for the treatment of coronary in-stent restenosis

目的 研究切割球囊 (CBA)和切割球囊联合血管内放射 (IBT)治疗支架内再狭窄 (ISR)的可行性 ,并比较两组的疗效。方法 对 4 1例支架内再狭窄患者4 7处病变随机分成 3组 ,对照组 12例 14处病变 ,仅以普通球囊扩张治疗 ;CBA组 14例 15处病变 ,主要以切割球囊治疗 ;CBA +IBT组 15例 18处病变 ,以切割球囊联合血管内放射治疗为主。随访 6～ 8mon ,观察终点为观察期间出现心绞痛 (AP)伴随同以往相似的心电图改变、心肌梗死 (MI)、目标血管病变处的血运重建 (TLR)、非目标血管病变处的血运重建等 (NTLR)。如无以上情况 ,则行冠状动脉造影检查 ,对比 3组的参照血管直径 (RVD)、最小管腔直径 (MLD )、即刻所得 (AG)、后期丢失(LL)、丢失指数 (LI)等参数 ,并观察其再再狭窄(RRS)的情况。结果 3组的AP、MI、TLR、NTLR的发生率相似 ,无显著性差异 (P >0 .0 5 ) ;而CBA组和CBA +IBT组的LL、LI、RRS明显低于对照组 ,而CBA组的AG明显高于其他两组 ,并均有显著性差异 (P <0 .0 5 )。结论 CBA和IBT均能有效的防治IRS ,CBA的疗效似更优于CBA +IBT。

Aim To evaluate and compare the feasibility and clinical outcomes of cutting balloon angioplasty (CBA) and cutting balloon combined with intravascular brachytherapy (IBT) for the treatment of coronary in-stent restenosis. Methods 41 patients (47 lesions) with in-stent restenosis(ISR) were randomly divided into three groups, the patients in the control group were treated by plain old balloon angioplasty (POBA), and in CBA group with CBA, and in CBA+IBT group by CBA combined with IBT. All the patients were followed up for 6 to 8 months. The end-points of the observation were angina pectoris (AP) accompanied by electrocardiogram changes similar to before the treatment, myocardial infarction(MI), target-lesion revascularization (TLR) and nontarget-lesion revascularization (NTLR). If nothing happened, acute gain (AG), late loss (LL), loss index (LI), and re-restenosis (RRS) would be compared among the three groups by quantitative coronary angiography after 6 to 8 months. Results The incidences of AP, MI, TLR and NTLR were similar in three groups(P> 0.05); the levels of LL, LI, RRS in CBA group and CBA+IBT group were significantly lower than those in control group(P< 0.05) and AG in CBA group was higher than that in other two groups(P< 0.05). Conclusion CBA and IBT are effective in treatment of ISR, and CBA seems to be prior to CBA+IBT.