药物涂层球囊治疗原位大血管病变预扩张时切割球囊的应用技巧

Application Skills of Cutting Balloon in the Treatment of in Large De Novo Coronary Lesions with Drug-Coated Balloon

目的探索应用切割球囊预扩张冠心病原位大血管病变的技巧,以降低夹层的发生率和提高药物涂层球囊(DCB)的成功率。方法回顾性分析560例为行DCB而使用切割球囊预扩张病变的患者,分为试验组(“点式小压力扩张联合整体扩张”)和对照组(常规扩张)。试验组先在病变最狭窄处及两端做3~5 atm(1 atm=1.013×10^(5) Pa)“小压力点式扩张”,之后常规6~10 atm依次全程扩张。对照组用切割球囊直接常规6~10 atm压力从病变远端至近端依次扩张。使用倾向性评分匹配的方法将两组患者进行匹配,观察两组患者术中C型及以上血管夹层的发生率。结果试验组和对照组使用切割球囊预扩张后C型及以上夹层的发生率分别为0.42%和17.37%,差异有统计学意义(P<0.05);两组DCB应用率分别为99.58%和82.63%,差异有统计学意义(P<0.05);两组DCB释放后新出现或加重为C型及以上夹层为0.42%和5.51%,差异有统计学意义(P<0.05)。结论使用切割球囊时以“点式小压力扩张联合整体扩张”的处理方式比常规处理方式发生C型及以上夹层的概率低,DCB应用成功率高,是值得在临床上推广的药物球囊预扩张的方式。

Objective To explore the technique of applying cutting balloon to pre-dilation in order to reduce the incidence of dissection and improve the success rate of drug-coated balloon(DCB)in large de novo coronary lesions.Methods The 560 patients who used cutting balloons to precondition the lesions for DCB were divided into the experimental group(“small pressure-point expansion and overall expansion”)and the control group(conventional expansion).The experimental group first performed 3-5 atm(1 atm=1.013×10^(5) Pa)“small pressure-point expansion”at the narrowest part and both ends of the lesion,and then conventional 6-10 atm cuts in sequence.In the control group,the cutting balloon was used to directly expand with conventional 6-10 atm pressure from the distal end to the proximal end.Propensity score matching method was used to match the two groups of patients,and the incidence of intraoperative type C and above vascular dissection in the two groups was observed.Results The pretreatment of the experimental group and the control group with the cutting balloon was 0.42%and 17.37%for dissection of type C and above,and the difference was statistically significant(P<0.05).The application rate of DCB in the two groups was 99.58%and 82.62%,and the difference was statistically significant(P<0.05).New or aggravated dissection of type C and above after the release of DCB was 0.42%and 5.51%,and the difference was statistically significant(P<0.05).Conclusion The cutting balloon with“point-type small pressure expansion and overall expansion”has less incidence of dissection of type C and above than the control group,and the success rate of DCB application is higher.It is a pretreatment technique worthy of clinical promotion.