药物洗脱支架联合药物涂层球囊治疗原位冠状动脉弥漫病变的初步分析

Safety and Efficacy of Hybrid Strategy Combining Drug-eluting Stent and Drug-coated Balloon for the Treatment of de Novo Diffuse Coronary Artery Disease

目的:探讨药物洗脱支架(DES)联合药物涂层球囊(DCB)治疗原位冠状动脉弥漫病变的安全性和疗效。方法:纳入2018年1月至2020年12月期间我院行DES联合DCB治疗原位冠状动脉弥漫病变的患者57例。主要研究终点为操作成功。记录患者临床基线资料、介入操作特征和随访结果,评价其安全性和疗效。结果:共有57例患者60个靶病变纳入,患者平均年龄(59.9±10.2)岁,男性43例(75.4%),33例(57.9%)合并2型糖尿病。平均置入DES(1.4±0.7)枚,平均应用DCB(1.1±0.3)个。50个(83.3%)病变在近段血管直径较大处置入DES,而远段血管直径较小处应用DCB扩张。术前DES治疗节段的参照血管直径大于DCB治疗节段(P<0.001),且病变长度更长(P<0.001)。DCB治疗节段出现术后夹层16个(26.7%),其中A型夹层5个(8.3%),B型夹层11个(18.3%)。所有患者均操作成功,且无院内急性血栓事件发生。在平均随访(18.2±9.2)个月期间,2例(3.5%)患者发生靶病变血运重建,其中1例(1.8%)因支架内再狭窄应用DCB治疗,1例(1.8%)因急性支架内血栓导致急性心肌梗死行靶病变血运重建。结论:DES联合DCB治疗可在一定程度上减少永久性支架梁的置入,是治疗原位冠状动脉弥漫病变一种潜在可行的方法。

Objective:To investigate the safety and efficacy of hybrid strategy combining drug-eluting stent(DES)and drug-coated balloon(DCB)for the treatment of de novo diffuse coronary artery disease.Methods:Patients,who underwent percutaneous coronary intervention of de novo diffuse coronary artery disease through hybrid strategy in Fuwai Hospital from January 2018 to December 2020,were included in this analysis.The primary endpoint was procedural success.Baseline demographic characteristics,operation features and follow-up data were analyzed.Results:A total of 57 patients with 60 target lesions were enrolled.Mean age was(59.9±10.2)years,43(75.4%)patients were men and 33(57.9%)patients had type 2 diabetes mellitus.The average number of implanted DES and DCB was 1.4±0.7 and 1.1±0.3,respectively.DES were implanted in the larger,more proximal lesion site and DCB were applied in the more distal,smaller lesion site of 50(83.3%)lesions.The reference vessel diameter was larger(P<0.001)and lesion length was longer(P<0.001)in DES-treated segment than in DCB-treated segment.In DCB-treated segment,coronary artery dissection occurred in 26.7%sites(n=16)in which 8.3%was type A dissection(n=5)and 18.3%was type B dissection(n=11).Procedural success was obtained in all patients and there was no in-hospital acute thrombosis event.Follow-up was conducted in all patients and mean follow-up time was(18.2±9.2)months.Target lesion revascularization occurred in 2(3.5%)patients.One patient(1.8%)developed in-stent restenosis and was treated with DCB.One patient(1.8%)underwent revascularization because of acute myocardial infarction due to acute stent thrombosis.Conclusions:Our preliminary data showed that hybrid strategy could reduce the implantation of permanent stent scaffold and is a promising alternative for the treatment of de novo diffuse coronary artery disease.