切割球囊联合药物洗脱球囊在急性心肌梗死小血管罪犯病变中的短期疗效分析

Analysis of short-term curative effect of cutting balloon and drug eluting balloon in treating small culprit vessel with acute myocardial infarction

目的分析切割球囊联合药物洗脱球囊(drug eluting balloon,DEB)在急性心肌梗死(acute myocardial infarc-tion,AMI)小血管罪犯病变中的应用情况及术后短期疗效。方法选取2017年1月至2018年12月北京京煤集团总医院急诊造影结果显示冠状动脉小血管闭塞导致AMI患者62例,均使用切割球囊联合DEB(SeQuent Please)介入治疗,观察切割球囊联合DEB扩张后最小管腔直径(minimum lumen diameter,MLD)、管腔狭窄程度、不良反应及并发症情况。并于术后1个月及9个月各随访1次,记录不良事件的发生情况。结果切割球囊联合DEB在AMI小血管罪犯病变中应用共有62处病变,使用62个DEB,其中左前降支(left anterior descending,LAD)8个、对角支(diagonal branch,D)25个、左回旋支(left circumflex,LCX)6个、钝缘支(obtuse marginal,OM)10个、左室后侧支(posterior lateral branch,PLB)6个、后降支(posterior descending artery,PDA)7个。术后MLD值较术前明显增加([2.1±0.3)mm比(0.0±0.0)mm],差异有统计学意义(P<0.01),术后管腔狭窄程度较术前显著降低([22.6±8.6)%比(100.0±0.0)%],差异有统计学意义(P<0.01)。术后9个月复查,1例左前降支发生再次闭塞(无临床症状),因可疑金属过敏再次DEB治疗,主要不良心脏事件(majoradverse cardiovascular events,MACE)发生率为1.6%。结论切割球囊联合DEB在AMI小血管罪犯病变中的治疗是可行的,为临床提供了新思路。

Objective To analyze the short-term efficacy of cutting balloon and drug eluting balloon(DEB)in the pathogenesis of small vessel criminals in acute myocardial infarction(AMI).Methods A total of 62 patients with AMI were enrolled in the emergency angiography from January 2017 to December 2018.All patients were treated with cutting-balloon and DEB(paclitaxel-eluting balloon,SeQuent Please).The minimum lumen diameter(MLD),the degree of stenosis and adverse reactions and complications were observed.All patients were followed up to nine months after surgery.Results Cutting balloon combined with DEB was used in 62 small vessel culprit lesions of AMI,including eight left anterior descending(LAD),25 diagonal branches(D),six left circumflex branches(LCX)and 10 obtuse marginal(OM),six posterior lateral branches(PLB)and seven posterior descending branches(PDA).No complications occurred during and after operation.The incidence of MACE was 1.6%,occurred after follow-up.The MLD was significantly increased compared with that before operation[(2.1±0.3)mm vs.(0.0±0.0)mm,P<0.01],and the degree of postoperative stenosis was significantly lower than that before operation[(22.6±8.6)%vs.(100.0±0.0)%,P<0.01].Conclusions The short-term efficacy of cutting balloon and DEB in the pathogenesis of small culprit vessel with AMI is feasible,which provides a new idea for the treatment of small vessel criminal lesions in AMI.