准分子激光与旋磨术在冠状动脉支架再狭窄治疗中的作用

目的比较准分子激光与旋磨及常规球囊对冠状动脉支架内再狭窄治疗的效果。方法将461例单支冠状动脉病变支架内再狭窄患者分别用准分子激光、旋磨术与常规球囊进行扩张治疗,并在治疗后即刻及6个月时再次行冠状动脉造影并进行定量分析。结果介入治疗前各组间支架内再狭窄情况无明显区别;准分子激光和旋磨后加PTCA即刻所获得的冠状动脉支架内最小血管直径(MLD)显著高于常规球囊治疗组(P<0.05),且旋磨与准分子激光组间无明显差异(P>0.05);6个月后准分子激光及旋磨组治疗组冠状动脉支架内血管直径明显低于常规球囊治疗组(P<0.05),且旋磨及准分子激光组无显著性差异(P>0.05)。旋磨与准分子激光及常规球囊治疗组支架内血管直径狭窄率分别为57.17%、54.78%及38.31%;准分子激光及旋磨组后期血管丢失量高于常规球囊治疗组(P<0.05)。结论准分子激光及旋磨对冠状动脉支架内再狭窄即刻疗效明显优于常规球囊治疗组,但6个月后支架内再狭窄率高于常规球囊治疗组,因而不宜首选用作支架内再狭窄的治疗。

Comparsion of excimer laser coronary angioplasty with rotational atherectomy in treating in-stent restenosis

Objectives To determine which method is better in treating in-stent restenosis(ISR).Methods A total of 461 single lesions treated for ISR were divided into three groups according to treatment strategy: Conventional percutaneous transluminal coronary angioplasty(PTCA),Excimer laser coronary angioplasty(ELCA),and Rotational atherectomy(ROTA).After 6-month follow-up,coronary angiography was performed again for the 3 groups.Results ① Baseline clinical and angiographic were similar among the groups(P=NS).② Among the three groups,the minimal lumen diameter(MLD) was significantly higher in the ROTA and ELCA groups following PTCA(P<0.05),and there was no significant difference between ROTA and ELCA groups(P>0.05).③ at six-month follow-up,the MLD in ROTA and ELCA was lower than the conventional PTCA group(P<0.05).The PTCA yielded a lowest recurrent restenosis rate(38.31%).The ELCA group had a restenosis rate of 57.17%,and the ROTA group 54.78%.④ The ELCA and ROTA groups have a higher rate of lumen loss compared with PTCA group(P<0.05).Conclusion The ROTA and ELCA have immediate results superior to PTCA and CBA,but worse angiographic outcomes at 6-month follow-up.