切割球囊联合血管内近距离放射治疗支架内再狭窄

Treatment of in-stent restenosis by combining cutting balloon angioplasty and intravascular brachytherapy

目的 探讨切割球囊 (CBA)联合血管内近距离放射疗法 (IVBT)治疗冠状动脉支架内再狭窄 (ISR)的临床应用价值。方法 距支架植入平均 6 7个月、冠状动脉造影 (CAG)证实的ISR患者 36例 ,1组 (2 0例 )用 10mm长、直径与参考血管比为 1 1∶1的CBA ,2组 (16例 )用普通球囊(POBA) ,扩张满意后均放置 4 0mm长的放疗导管覆盖病变处并行照射 ;CAG测量最小管腔直径(MLD)、即刻所得 (AG) ;随访 4～ 8个月 ,观察终点为主要心血管事件 (MAE ,即死亡、急性心肌梗死、靶血管的血运重建 ) ,CAG复测MLD及晚期丢失 (LL)、丢失指数 (LI)、再再狭窄 (RRS)率等参数。结果 AG 1组略高于 2组 (P >0 0 5 ) ;MAE发生率 1组 (10 % )显著低于 2组 (18 8% ,P <0 0 5 ) ;LL、LI、MAE、RRS参数 1组 (0 16± 0 2 7mm ,0 0 5± 0 0 1,10 % ,15 % )明显低于 2组 (0 32±0 31mm ,0 11± 0 0 2 ,4 3 8% ,37 5 % ) ,均P <0 0 5。结论 CBA联合IVBT治疗ISR安全、可行 ,其疗效优于POBA联合IVBT。

Objective To investigate the clinical value of treatment of in stent restenosis (ISR) by combining cutting balloon angioplasty (CBA) and intravascular brachytherapy (IVBT).Methods 36 patients with ISR confirmed by coronary angiogram (CAG) average 6 7 months after first stenting were divided into CBA+IVBT group (Group 1,with 20 cases)which were treated by a 10mm long cutting balloon with ratio of diameter and conference vessel were 1 1∶1,and plain old balloon angioplasty(POBA)+IVBT group (Group 2,with 16 cases)which were treated by a plain old balloon firstly,and then radiation therapy were used with a 40mm long radiation catheter covering the whole lesion.Minimal lumen diameter (MLD)and acute gain (AG)were checked by CAG.The primary end point included death,myocardial infarction and target vessel revasculrization.Procedural parameters included MLD,AG,late loss (LL),ratio of restenosis (RRS) and loss index (LI)were determined during follow up after first PCI 4～8 months.Results During follow up,there was a significant advantage in terms of major adverse events for Group 1 [10% versus 18 8% for Group 2 ( P< 0 05)],and LL,LI,MAE and RRS for Group 1 were significantly lower than that for Group 2[(0 16±0 27mm,0 05±0 01,10%,15% versus 0 32±0 31mm,0 11±0 02,43 8%,37 5%( P< 0 05)).[WTHZ]Conclusion These results show that the feasibility and safety of the strategy of combining cutting balloon angioplasty followed by IVBT.They demonstrated additional clinical benefit at 4～8 months follow up with this strategy compared to conventional PTCA and IVBT.