杂交策略治疗冠状动脉慢性完全闭塞病变的有效性和安全性

目的 探讨药物洗脱支架（drug-eluting stent, DES）联用药物涂层球囊（drug-coated balloon, DCB）的杂交策略治疗冠状动脉慢性完全闭塞（chronic total occlusion, CTO）病变的有效性和安全性。方法 连续纳入2021年9月至2022年9月在复旦大学附属中山医院确诊为CTO并采用单纯DES植入或杂交策略治疗的369例患者，分为DES组（n=220）和杂交策略组（n=149）。比较两组患者的临床基线信息、介入手术特征、术后定量冠状动脉造影（quantitative coronary angiography, QCA）参数和定量血流分数（quantitative flow ratio, QFR）。随访术后1个月内主要不良心血管事件（major adverse cardiovascular events, MACE）发生率。结果 369例患者的369个病变以前降支病变（44.7%）和右冠状动脉病变（43.1%）为主。与DES组相比，杂交策略组植入支架数[1.67±0.66 vs 2.00±0.81, P<0.001]和植入支架...

Efficacy and safety of hybrid strategy in the treatment of chronic total occlusion

Objective To evaluate the efficacy and safety of hybrid treatment strategy based on the combination of drug-eluting stents (DES) plus drug-coated balloons (DCB) in the treatment of chronic total coronary artery occlusion (chronic total occlusion, CTO). Methods A total of 369 patients diagnosed with CTO lesions and treated with drug-eluting stents only or hybrid strategy were consecutively enrolled from Zhongshan Hospital, Fudan University between September 2021 and September 2022. The clinical characteristics, percutaneous coronary intervention (PCI) related data, parameters of quantitative coronary angiography (QCA) and quantitative flow ratio (QFR), the incidence of major adverse cardiovascular events (MACE) within one-month follow-up were compared between DES group and hybrid strategy group. Results There were 369 CTO lesions were included, mainly in left anterior descending coronary artery (LAD,44.7%) and right coronary artery (RCA,43.1%). Compared with the DES group, patients in the hybrid treatment strategy group had lower number (1.67±0.66 vs 2.00±0.81, P<0.001), total length [(51.53±21.52) mm vs (58.63±26.95) mm, P=0.005] of implanted stents and higher immediate post-PCI QFR of the target vessel [0.94(0.91,0.97) vs 0.96(0.93,0.98), P=0.045]. No MACE occurred in both groups. Conclusion In the interventional treatment of CTO lesions, compared with drug-eluting stent only strategy, hybrid strategy combined with DCB and DES significantly reduced stent implantation and improved functional blood supply, and does not increase the incidence of short-term MACE.