目的:通过meta分析评价药物涂层球囊(DCB)与普通球囊血管成形术(POBA)或药物洗脱支架(DES)对冠状动脉小血管原发病变(SVD)的治疗效果。方法:检索Cochrane Library、PubMed、Web of Science、Embase、CBM、中国知网、万方、维普数据库,...目的:通过meta分析评价药物涂层球囊(DCB)与普通球囊血管成形术(POBA)或药物洗脱支架(DES)对冠状动脉小血管原发病变(SVD)的治疗效果。方法:检索Cochrane Library、PubMed、Web of Science、Embase、CBM、中国知网、万方、维普数据库,检索时限为建库至2023年4月。采用RevMan 5.3和Stata 15.1软件进行meta分析和发表偏倚检验,根据不同的对照措施分亚组进行分析。结果:共纳入14篇RCT,包括3 354例患者。Meta分析显示,与POBA相比,DCB可降低SVD患者的靶病变血运重建(TLR)和再狭窄(BR)发生率,减少晚期管腔丢失(LLL)和管腔直径狭窄度(DS),增加最小管腔直径(MLD);但对主要不良心血管事件(MACE)和靶血管血运重建(TVR)发生率的影响,差异无统计学意义。与DES相比,DCB可降低SVD患者的MACE发生率,减少LLL和MLD,增加DS;但对TLR、TVR和BR发生率的影响,差异无统计学意义。结论:与POBA和DES相比,DCB可在一定程度上改善SVD患者的预后,减少LLL,但仍需纳入更多大样本、高质量的RCT来验证其对其他结局指标的影响。展开更多
原发病变一词译自“de novo lesion”,“de novo”来源于拉丁文,原意是指从头开始、重新,在介入学中引申为既往未经过干预的狭窄病变。这里的干预包括球囊扩张、支架置入及旋磨、旋切、激光消蚀、放射治疗等斑块减容(debulk)操作。在药...原发病变一词译自“de novo lesion”,“de novo”来源于拉丁文,原意是指从头开始、重新,在介入学中引申为既往未经过干预的狭窄病变。这里的干预包括球囊扩张、支架置入及旋磨、旋切、激光消蚀、放射治疗等斑块减容(debulk)操作。在药物涂层球囊(drug-coated balloon,DCB)的研究中,de novo病变多指除支架内再狭窄、部分小血管病变和特殊的复杂病变(真分叉病变、慢性完全闭塞病变、钙化病变、血栓病变、桥血管病变等)以外的病变,也就是我们日常介入工作中常见的未经干预的病变。展开更多
The aim of this study was to establish safety and feasibility of oral Rapamyci n at two doses -2 mg and 5 mg -in achieving low rates of repeat target lesion revascularization (TLR) in de novo native coronary artery le...The aim of this study was to establish safety and feasibility of oral Rapamyci n at two doses -2 mg and 5 mg -in achieving low rates of repeat target lesion revascularization (TLR) in de novo native coronary artery lesions. Drug eluting stents have shown the ability to limit restenosis. Oral Rapamycin is an alterna tive strategy that can target multiple coronary lesions suitable for treatment w ith any approvedmetal stent and at potentially lower cost. The Oral Rapamune to Inhibit Restenosis (ORBIT) study is an open label study of 60 patients with de novo lesions treated with bare metal stents in up to two vessels. After a loadin g dose of 5 mg, patients received a daily dose of 2 mg (n=30) and 5 mg(n=30) for 30 days. Six month angiographic, intravascular ultrasound(IVUS), and clinical follow up were conducted. Baseline clinical and procedural characteristics were similar: 10%of patients in the 2-mg group and 30%in the 5-mg group did not complete the course; 43%in the 2-mg group and 66%in the 5-mg group had side effects. At six month follow up, late loss (0.6 ±0.5 mm vs. 0.7 ±0.5 mm; p=N S), in stent binary restenosis (7.1%vs. 6.9%; p=NS), in stent percent volume obstruction by IVUS (29%vs. 24%; p=NS), and clinically driven TLR (14.3%vs. 6.9%; p=NS) were similar in 2-mg and 5-mg groups. Oral Rapamycin for the prev ention of restenosis is safe, feasible, and associated with low rates of repeat revascularization. Although associated with certain side effects, it may be cons idered for patients undergoing multivessel stents if proven in larger randomized studies.展开更多
文摘The aim of this study was to establish safety and feasibility of oral Rapamyci n at two doses -2 mg and 5 mg -in achieving low rates of repeat target lesion revascularization (TLR) in de novo native coronary artery lesions. Drug eluting stents have shown the ability to limit restenosis. Oral Rapamycin is an alterna tive strategy that can target multiple coronary lesions suitable for treatment w ith any approvedmetal stent and at potentially lower cost. The Oral Rapamune to Inhibit Restenosis (ORBIT) study is an open label study of 60 patients with de novo lesions treated with bare metal stents in up to two vessels. After a loadin g dose of 5 mg, patients received a daily dose of 2 mg (n=30) and 5 mg(n=30) for 30 days. Six month angiographic, intravascular ultrasound(IVUS), and clinical follow up were conducted. Baseline clinical and procedural characteristics were similar: 10%of patients in the 2-mg group and 30%in the 5-mg group did not complete the course; 43%in the 2-mg group and 66%in the 5-mg group had side effects. At six month follow up, late loss (0.6 ±0.5 mm vs. 0.7 ±0.5 mm; p=N S), in stent binary restenosis (7.1%vs. 6.9%; p=NS), in stent percent volume obstruction by IVUS (29%vs. 24%; p=NS), and clinically driven TLR (14.3%vs. 6.9%; p=NS) were similar in 2-mg and 5-mg groups. Oral Rapamycin for the prev ention of restenosis is safe, feasible, and associated with low rates of repeat revascularization. Although associated with certain side effects, it may be cons idered for patients undergoing multivessel stents if proven in larger randomized studies.
