药物球囊在冠脉介入应用中的研究进展

Advances of drug-coated balloon in percutaneous coronary intervention

经皮冠脉成形术是指通过各种方法扩张狭窄的冠状动脉,从而达到解除狭窄、改善心肌血供的一种治疗手段。介入相关材料不断发展,从裸金属支架到药物洗脱支架,再到近年流行的药物涂层球囊。金属支架的发明很大程度解决了冠脉狭窄的问题,但是长期抗血小板治疗带来的副作用以及支架内再狭窄等问题一直困扰着人们。药物涂层球囊与传统支架相比拥有不少理论上的优势,因此成为冠脉介入治疗的新选择。它能够向血管内膜均匀地涂布抗增殖药物,在减少内膜增生的同时不留下任何植入物,从而使血管保持原有的解剖结构和功能。目前,多数临床试验证明药物涂层球囊治疗支架内再狭窄与药物洗脱支架拥有类似的效果,并且不会引入额外的支架,因此更能体现不植入永久性支架的理念。此外,在治疗小血管病变、分叉病变、慢性完全闭塞性病变、弥漫性病变时,药物涂层球囊也体现出相应的优势。现本文就药物涂层球囊在不同冠脉病变中应用的有效性及相关研究进展进行综述。

Percutaneous coronary intervention is a novel therapy aiming to expand the narrow coronary arteries,relieving stenosis and improving myocardial blood supply with the usage of various techniques.Interventional materials evolve from bare metal stents to drug-eluting stents and,more recently,drug-coated balloons.Though metal stents largely solve the problem of coronary artery stenosis,long-term anti-platelet therapy and stent restenosis remain troubling.The drug coated balloon(DCB)platform offers several theoretical benefits over stent-based technologies.It has emerged as an additional tool in the arsenal of interventional cardiology devices.It allows the homogenous transfer of an anti-proliferative drug to reduce neo-intimal hyperplasia whilst potentially maintaining normal vessel anatomy and function,leaving no implant behind.The body of evidence supporting the role of DCB in the treatment of in-stent restenosis is more substantial and appears to yield similar results to DES without the introduction of an additional stent layer.Therefore,the concept of permanent implantation of stents can be better represented by the treatment of drug coated balloon.Meanwhile,DCB exerts beneficial effects in the treatment of some lesion subsets,including small vessel diseases,side branch bifurcations,chronic total occlusions and diffuse lesions.This review focuses on the rationale for DCB usage,effectiveness of DCBs in different clinical and lesion settings,and provides practical tips for their correct use in everyday clinical practice.