单纯药物涂层球囊治疗冠状动脉左主干分叉病变的效果

Treatment of Left Main Coronary Artery Bifurcation Lesion with Drug Coated Balloon-Only Strategy

目的观察单纯药物涂层球囊(DCB-only)治疗冠状动脉左主干分叉病变的效果与安全性。方法回顾性分析2018年1月至2019年12月至郑州大学第一附属医院就诊,经冠状动脉造影(CAG)检查证实为冠状动脉左主干分叉病变,且接受DCB-only策略治疗的患者35例,通过回顾住院病历以及门诊和电话随访的方式对所有患者进行追踪,随访的终点是复查CAG和主要不良心血管事件(MACE)的发生。记录术前、术后即刻及复查CAG时各靶血管的最小管腔直径(MLD),计算相应的管腔狭窄程度及复查时的晚期管腔丢失(LLL)。结果35例患者术后即刻复查CAG,靶血管病变处MLD较术前明显增加,管腔狭窄程度较术前明显降低(P<0.05),所有患者围术期无MACE发生。16(45.71%)例患者返院复查CAG,CAG中位随访时间7.00(6.00,11.75)个月。随访期间1(2.86%)例患者接受了靶病变血运重建。其余15例患者随访时靶血管病变处MLD较术前明显增加,管腔狭窄程度较术前明显降低(P<0.05);与术后即刻相比,差异无统计学意义(P>0.05)。随访时靶血管病变处LLL分别为:左主干(0.16±0.21)mm,左前降支(-0.02±0.18)mm,左回旋支(-0.06±0.25)mm。结论DCB-only策略治疗冠状动脉左主干分叉病变是有效的,并且相对安全,这为未来冠状动脉左主干分叉病变的诊疗提供了新的思路。

Objective To evaluate the efficacy and safety of drug coated balloon-only strategy in left main coronary artery bifurcation lesion.Methods Thirty-five patients were enrolled in this study who were diagnosed as left main coronary artery bifurcation lesion by coronary angiography(CAG)and treated with drug-coated balloon only strategy(DCB-only)from January 2018 to December 2019 in the First Affiliated Hospital of Zhengzhou University.All of the patients were tracked by reviewing inpatient medical records,outpatient and telephone follow-up.The endpoint of follow-up was the re-check of CAG and the occurrence of major adverse cardiovascular events(MACE).Minimum lumen diameter(MLD)of target vessels was measured before and immediately after percutaneous coronary intervention(PCI),and during the follow-up,then late luminal loss(LLL)was calculated.Results CAG was performed immidiately after PCI in all patients.Compared with that before PCI,MLD of target lesions immediately after PCI was significantly increased,and the degree of lumen stenosis was significantly decreased(P<0.05).No MACE occurred during the perioperative period.CAG was reviewed in 16(45.71%)patients after a median time of 7.00(6.00,11.75)months.During follow-up period,1(2.86%)patient underwent target lesion revascularization.For the other 15 patients,MLD of target lesions at follow-up was significantly higher than that before PCI,and the degree of lumen stenosis was significantly lower(P<0.05).However,the follow-up MLD and degree of lumen of target lesions were similar with that immediately after PCI(P>0.05).The LLL at follow-up:LM(0.16±0.21)mm,LAD(-0.02±0.18)mm,LCX(-0.06±0.25)mm.Conclusion The treatment of left main coronary artery bifurcation lesions with DCB-only strategy is effective and relatively safe,which provides new ideas for the diagnosis and treatment of left main coronary artery bifurcation lesions in the future.