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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:

37

期数:

2020年8

页码:

769-772

栏目:

临床研究

出版日期:

2020-08-05

文章信息/Info

Title:

Effect of drug-coating balloon combined with cutting balloon angioplasty in the treatment of ostial lesions of the left anterior descending coronary artery

作者:

刘新锋¹; 关玲霞¹; 潘家华²

（1.驻马店市中心医院心血管内一科，河南　驻马店　463000；2.云南省阜外心血管病医院心内科，云南　昆明　650000）

Author(s):

LIU Xinfeng¹; GUAN Lingxia¹; PAN Jiahua²

(1.Department of Cardiovascular Medicine,Zhumadian Central Hospital,Zhumadian 463000,Henan Province,China;2.Department of Cardiovascular Medicine,Fuwai Yunnan Cardiovascular Hospital,Kunming 650000,Yunnan Province,China)

关键词:

冠状动脉左前降支开口病变; 药物涂层球囊; 切割球囊; 药物洗脱支架; 冠状动脉造影

Keywords:

ostial lesions of the left anterior desending coronary artery; drug-coating balloon; cutting balloon; drug-eluting stent; coronary arteriography

分类号:

R541.4

DOI:

10.7683/xxyxyxb.2020.08.016

文献标志码:

A

摘要:

目的　观察药物涂层球囊（DCB）联合切割球囊预扩张治疗冠状动脉左前降支开口病变临床效果及安全性。方法　选择2016 年10月至2019年1月驻马店市中心医院收治的64例冠状动脉左前降支开口病变患者为研究对象，根据治疗方法分为观察组（n=34）和对照组（n=30），观察组患者采用DCB联合切割球囊介入治疗，对照组患者采用药物洗脱支架介入治疗。观察2组患者冠状动脉造影（CAG）显示的靶血管病变特征、术中对比剂使用量、手术时间、血管夹层、血栓及左回旋支（LCX)开口受累情况；术后6～12个月复查CAG，观察靶血管再狭窄及再次血运重建率；观察住院及随访期间主要不良心脏事件（MACE）发生率。结果　2组患者冠状动脉左主干均无明显狭窄。2组患者靶血管基准直径、病变长度、狭窄程度、血管钙化比例、偏心狭窄比例及LCX开口狭窄>50%所占比例比较差异均无统计学意义（P>0.05）。观察组无LCX开口受累狭窄>70%患者，对照组6例患者LCX开口受累狭窄>70%，改行双支架植入治疗。观察组和对照组患者术中对比剂使用量分别为（75.4±14.1）、（120.8±19.3）mL，观察组患者术中对比剂使用量显著少于对照组（t=4.947，P<0.05）。观察组和对照组患者手术时间分别为（36.2±9.9）、（61.8±13.3）min，观察组患者手术时间显著短于对照组（t=5.142，P<0.05）。观察组患者住院期间发生急性心肌梗死1例，MACE发生率为2.9%（1/34）；对照组患者住院期间无MACE发生；2组患者住院期间MACE发生率比较差异无统计学意义（χ²=0.896，P>0.05）。经皮冠状动脉介入术后6～12个月，观察组30例患者获得随访并行CAG检查，随访率为88.2％（30/34），靶血管再狭窄发生率为16.7％（5/30），靶血管重建率为6.7%（2/30）；对照组27例患者获得随访并行CAG检查，随访率为90.0％（27/30），靶血管再狭窄率为7.4％（2/27），无靶血管再重建患者；2组患者靶血管再狭窄率、靶血管重建率比较差异均无统计学意义（χ²=1.131、1.865，P>0.05）。随访期间2组患者均无死亡及心肌梗死等MACE发生。结论　DCB联合切割球囊治疗冠状动脉左前降支开口病变可以缩短手术时间，减少对比剂使用量，减轻术中对LCX开口的影响，是安全有效的治疗方法。

Abstract:

Objective　To investigate the effect and safety of drug-coating balloon (DCB) combined with cutting balloon angioplasty in the treatment of ostial lesions of the left anterior desending coronary artery.Methods　Sixty-four patients with ostial lesions of the left anterior descending coronary artery admitted to Zhumadian Central Hospital from October 2016 to January 2019 were selected as the study subjects.The patients were divided into the observation group (n=34) and the control group (n=30) according to the treatment method.The patients in the observation group were treated by DCB combined with cutting balloon intervention,while the patients in the control group were treated with drug-eluting stent.The characteristics of target vessel lesion,the dosage of contrast agent,the operation time,the vascular dissection,the thrombus and the involvement of left circumflex branch (LCX) opening were observed by coronary angiography (CAG).The patients were reexamined by CAG at 6-12 months after operation,and the restenosis rate and revascularization rate of target vessel were observed.The incidence of major adverse cardiac events (MACE) was observed during hospitalization and follow-up.Results　There was no significant stenosis in the left main coronary artery of the patients in the two groups.There were no significant difference in the reference diameter,lesion length,degree of stenosis,ratio of angiosteosis and eccentric stenosis of target vessel and the ratio of LCX ostial stenosis > 50% between the two groups （P>0.05).There was no patient with LCX ostial stenosis >70% in the observation group.Six patients with the LCX ostial stenosis >70% underwent double stent implantation in the control group.The dosage of contrast agent in the observation group and the control group was (75.4±14.1) and (120.8±19.3) mL,respectively.The dosage of contrast agent in the observation group was less than that in the control group (t=4.947,P<0.05).The operation time in the observation group and the control group was (36.2±9.9) and (61.8±13.3) min,respectively.The operation time in the observation group was shorter than that in the control group (t=5.142,P<0.05).One patient experienced acute myocardial infarction during hospitalization in observation group,the incidence of MACE was 2.9% (1/34).There was no MACE during hospitalization in the control group.There was no significant difference in the incidence of MACE between the two groups (χ²=0.896,P>0.05).At 6-12 months after percutaneous coronary intervention,30 patients in the observation group were followed up and underwent CAG examination,the follow-up rate was 88.2% (30/34),the target vessel restenosis rate was 16.7% (5/30),and the target vessel reconstruction rate was 6.7% (2/30);27 patients in the control group were followed up and underwent CAG examination,the follow-up rate was 90.0% (27/30),the target vessel restenosis rate was 7.4% (2/27),but there was no patient with target vessel reconstruction.There was no significant difference in the target vessel restenosis rate and target vessel reconstruction rate between the two groups (χ²=1.131,1.865；P>0.05).No MACE such as death and myocardial infarction occurred in both groups during the follow-up period.Conclusion　DCB combined with cutting balloon angioplasty in the treatment of ostial lesions of the left anterior desending coronary artery can shorten the operation time,reduce the dosage of contrast agent and the influence on the LCX opening.It is a safe and effective treatment.

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更新日期/Last Update: 2020-08-05