非顺应球囊高压处理半顺应球囊不能扩张的冠状动脉病变的临床应用

Clinical application of non-compliant balloon high pressure in managing inexpansible coronary lesions by semi-compliant balloon

目的探讨使用非顺应性球囊高压扩张对常规半顺应性球囊不能扩张的冠状动脉病变的治疗效果,评估非顺应性球囊高压扩张对于部分不能扩张病变的安全性和有效性。方法回顾性分析2016年1月至2019年12月中国医学科学院阜外医院冠心病中心收治的36例常规半顺应性球囊不能充分扩张的冠状动脉狭窄病变的患者,首选非顺应性球囊高压扩张处理,观察手术成功率及并发症发生率,并随访住院期间主要不良心脑血管事件。结果36例患者中,使用高压非顺应性球囊扩张后,25例(69.4%)达到了病变充分扩张,随后顺利置入支架(3例为支架术后膨胀不全再狭窄患者);5例(13.9%)经旋磨治疗后使用顺应性球囊高压扩张后管腔扩张成功;1例(2.8%)旋磨后使用非顺应性球囊高压仍不能扩张病变;2例(5.6%)旋磨后常规半顺应性球囊仍不能充分扩张病变,经高压扩张最终置入支架;2例(5.6%)由于血管钙化迂曲非顺应性球囊不能到达病变处,旋磨后仍不能通过非顺应性球囊,仅适用半顺应性小球囊扩张病变;1例(2.8%)经高压球囊扩张后置入支架发现病变仍未充分扩张,使用非顺应性球囊高压扩张仍未成功,建议术后予加强抗血小板治疗。所有患者无血管穿孔等并发症及不良心脑血管事件发生。结论采用非顺应性球囊高压扩张常规球囊不能扩张的病变,为此类病变的预处理提供了简便有效的策略选择。

Objective To explore the effi cacy of non-compliant balloon by high pressure dilation for the inexpansible coronary lesions by routine semi-compliance balloon,and to evaluate the safety and efficacy of non-compliant balloon dilation by high pressure for part of the inexpansible coronary lesions.Methods Thirty-six patients with inexpansible coronary lesions by semi-compliant balloon admitted to Coronary Heart Disease Center of Fuwai Hospital,Chinese Academy of Medical Sciences from January 2016 to December 2019 were analyzed retrospectively.Non-compliant balloon by high pressure dilation was preferred.The success rate of operation and incidence of complications were observed.The major adverse cardiovascular and cerebrovascular events were followed up during hospitalization.Results Among 36 patients,the full expansion of lesions was achieved in 25 cases(69.4%)after non-compliant balloon high pressure dilation,the stent was then successfully placed(3 cases were incomplete stent dilation restenosis);and 5 cases(13.9%)achieved successful lumen dilation by compliant balloon high pressure dilation after rotational ablation treatment;one case(2.8%)did not achieve successful lumen dilation by non-compliant balloon high pressure dilation after rotational ablation treatment;two cases(5.6%)did not achieve successful lumen dilation by routine semi-compliant balloon high pressure dilation after rotational ablation treatment,the stent was then finally placed by high pressure dilation;because of calcified and tortuous vessels,non-compliant balloon could not reach to the lesions in two cases(5.6%),non-compliant balloon could not be used after rotational ablation,only semi-compliant small balloon dilatation lesions were applicable;the stent was placed by high pressure dilation,the lesion in one case(2.8%)was still not fully expanded,non-compliant balloon by high pressure dilation was failed,and antiplatelet therapy was strengthened.All patients had no complications of vascular perforation and adverse cardiovascular and cerebrovascular events.Conclusions Application of non-compliant balloon by high pressure dilation for the inexpansible coronary lesions by routine semi-compliance balloon can provide a simple and eff ective strategy selection for the pretreatment of such lesions.