血管内超声指导药物涂层球囊治疗冠状动脉小血管原发开口病变的疗效观察

Efficacy of intravascular ultrasound-guided drug-coated balloon in the treatment of primary ostial lesion in small vessels of coronary artery.

目的观察血管内超声(IVUS)指导药物涂层球囊(DCB)治疗冠状动脉小血管原发开口病变的疗效。方法回顾性分析2018年10月至2020年10月于咸阳市中心医院心血管内科接受治疗的126例冠状动脉小血管原发开口病变患者临床资料,根据患者自愿选择的治疗方法分为观察组67例(施行DCB)和对照组59例[施行药物洗脱支架(DES)]。比较两组患者治疗前、治疗6个月后的靶血管病变特征和治疗8个月后主要不良心血管事件(MACEs)发生情况。结果治疗6个月后,观察组患者的病变长度及靶血管狭窄程度分别为(12.05±4.31)mm、(9.01±1.25)%,明显低于对照组的(13.56±4.09)mm、(13.12±2.06)%,差异均有统计学意义(P<0.05);观察组患者治疗完成即刻及6个月后最小血管内径(MLD)分别为(2.28±0.25)mm、(1.80±0.24)mm,明显大于对照组的(2.26±0.29)mm、(1.51±0.21)mm,差异均有统计学意义(P<0.05);观察组患者治疗8个月后的靶病变血运重建发生率为2.99%,明显低于对照组的13.56%,差异有统计学意义(P<0.05),但两组患者的心源性死亡、非致死性急性心肌梗死生率比较差异均无统计学意义(P>0.05)。结论IVUS指导DCB可有效缓解冠状动脉小血管原发开口病变症状,促进病变血管修复,扩张狭窄血管,安全性较好,临床应用价值高。

Objective To observe the efficacy of intravascular ultrasound(IVUS)-guided drug-coated balloon(DCB)in the treatment of primary ostial lesion in small vessels of coronary artery.Methods The clinical data of 126 patients with primary ostial lesion in small vessels of coronary artery who were treated in the Department of Cardiovascular Medicine,Xianyang Central Hospital from October 2018 to October 2020 were retrospectively analyzed.The patients were divided into an observation group(67 patients,treated with IVUS-guided DCB)and a control group(59 patients,treated with drug-eluting stent DES) according to the treatment method chosen by themselves.The characteristics of target vascular lesions before and at 6 months after treatment,and the incidence of main adverse cardiovascular events(MACEs)at 8 months after treatment were compared between the two groups.Results At 6 months after treatment,the length of lesions and target vessel stenosis degree in the observation group were(12.05±4.31)mm and(9.01±1.25)%,significantly lower than(13.56±4.09)mm and(13.12±2.06)%in the control group(P<0.05).The minimum internal diameters(MLD)of the observation group immediately after treatment and at 6 months after treatment were(2.28±0.25)mm and(1.80±0.24)mm,significantly larger than(2.26±0.29)mm and(1.51±0.21)mm in the control group(P<0.05).The incidence of revascularization of the target lesions at 8 months after treatment was 2.99%,which was significantly lower than 13.56%in the control group(P<0.05).There was no significant difference in the rate of cardiac death and non-fatal acute myocardial infarction between the two groups(P>0.05).Conclusion IVUS-guided DCB can effectively relieve the symptoms of primary ostial lesion in small vessel of coronary artery,promote the repair of diseased vessels,and dilate the stenotic vessels,with good safety and high clinical application value.