药物涂层球囊联合切割球囊行冠状动脉分叉病变边支保护的疗效观察

Efficacy of drug-coating balloon and cutting balloon angioplasty in side branch protection for coronary bifurcation lesions

目的探索切割球囊联合药物球囊行冠状动脉分叉病变分支血管保护的即刻效果及远期预后。方法回顾性选取2017年1月至2018年6月解放军总医院收治的冠状动脉分叉病变患者60例为研究对象。依据治疗方法分为2组:研究组(n=28)和对照组(n=32)。研究组和对照组分别预埋药物球囊和普通球囊。比较2组患者基线资料、即刻手术效果、围手术期并发症,以及随访9个月发生的主要不良心血管事件(MACE)、靶病变血运重建和晚期管腔丢失(LLL)。采用SPSS24.0软件进行统计分析。依据数据类型,组间比较分别采用t检验或χ^2检验。结果2组患者术前病变类型及影像学参数、术后主支及分支血管最小直径和残余狭窄间差异无统计学意义(P>0.05)。2组患者围手术期均无并发症发生。研究组和对照组患者MACE发生率间差异具有统计学意义[25.8%(8/31)vs3.57%(1/28),P=0.044],但2组靶病变血运重建率[3.57%(1/28)vs9.88%(3/31),P>0.05]差异无统计学意义。部分患者术后9个月完成影像学复查,研究组和对照组主支直径及主支LLL差异无统计学意义(P>0.05),但分支血管最小直径[(2.50±0.48)vs(1.96±0.39)mm,P=0.013]及分支血管LLL[(0.04±0.07)vs(0.25±0.36)mm,P=0.024]间差异具有统计学意义(P<0.05)。结论切割球囊联合药物球囊在冠状动脉分叉病变分支保护中安全、有效。

Objective To evaluate the immediate and long-term effectiveness of applying cutting balloon angioplasty combined with drug-coating balloon (DCB) in side branch protection of coronary bifurcation lesions. Methods Sixty patients with coronary bifurcation lesions admitted in the Chinese PLA General Hospital from January 2017 to June 2018 were subjected in this study. They were divided into research group ( n =28) and control group ( n =32) according to use of DCB or ordinary balloon in the side breach after cutting balloon as pretreatment. Basic clinical data,instant effectiveness of operation,perioperative complications,and occurrences of major adverse cardiac events (MACE),target lesion revascularization (TLR) and late lumen loss (LLL) within 9 months after surgery were compared between the 2 groups. SPSS statistics 24.0 was used to perform the statistical analysis. Student′s t test or Chi-square test was employed for comparison between groups in different data types. Results There were no significant differences in lesion types,radiological parameters,postoperative stenosis and minimal lumen diameters (MLD) of main and side branches between 2 groups ( P >0.05). No perioperative complications was observed in both groups. The incidence of MACE within 9 months were significantly lower in the research group than in the control group [3.57%(1/28) vs 25.8%(8/31),P =0.044],but no difference was seen in the rate of TLR between them [3.57%(1/28) vs 9.88%(3/31),P >0.05]. Among the patients who underwent radiological examination in 9 months after surgery,there was no difference in the diameter and LLL of main branch between the 2 groups ( P >0.05 ),but statistical differences were seen in MLD [(2.50±0.48) vs (1.96±0.39)mm,P =0.013] and LLL [(0.04±0.07) vs (0.25±0.36)mm,P =0.024] of side branch. Conclusion DCB-combined cutting balloon angioplasty is effective and safe in side branch protection technique of coronary bifurcation lesions.