单纯药物涂层球囊策略治疗冠状动脉分叉病变分支血管的临床观察

目的观察单纯应用药物涂层球囊治疗冠状动脉分叉病变的安全性及有效性。方法入选我院心内科31例分叉病变患者(主支狭窄50%,分支开口狭窄70%;分支血管参考直径≥2mm),单纯应用药物涂层球囊处理分支血管,观察手术成功率、分支血管血流情况及并发症发生率,术后9个月行冠状动脉造影检查,记录随访过程中不良心血管事件(MACE)的发生情况。结果 31例患者33个分叉病变中位于前降支/对角支占57.58%,回旋支/钝缘支占30.30%,右冠状动脉/后降支或左室后支占12.12%。31例患者均成功完成分叉病变介入治疗,手术成功率100%,并且全部患者均经桡动脉途径完成。其中2列患者出现分支血管夹层(1例TIMI血流2级)进行补救性药物洗脱支架植入。围手术期及术后临床随访(门诊或电话随访),无死亡或心肌梗死等主要心脏不良事件发生。74.19%的患者完成了冠状动脉造影复查,仅1例行靶病变再次血运重建(TLR)。分支晚期管腔丢失(LLL)为(0.13±0.25)mm。结论单独药物涂层球囊策略处理冠状动脉分叉病变分支血管是安全有效的。

Clinical Observation of Simple Drug Coated Balloon Angioplasty in the Treatment of Coronary Bifurcation Lesions

Objective To investigate the safety and efficacy of side branch treatment with drug coated balloon (DCB) in coronary bifurcation lesions.Methods 31 patients with bifurcation lesions in Department of Cardiology of our hospital from November 2014 to July 2016 were selected in this study (main branches stenosis ＜ 50％,branch stenosis ＞ 70％;cahber of branch vessel≥2mm) and treated with simple DCB in branch vessel.The success rate of operation,blood flow of the branch vessels and incidence of comphcations were observed.Quantitifying coronary angiography (QCA) analysis was done after 9 months and the major adverse cardiovascular events (MACE) were recorded during 9 months' follow-up as well.Results Of 33 coronary bifurcation lesions in 31 patients,57.58％ were located in left anterior descending artery/diagonal branches,30.30％ were located in circumflex aaery/obtuse marginal branches,and 12.12％ were located in right coronary artery/posterior descending artery or posterior branch of left ventricle.31 patiems successfully completed the imervemional treatment of bifurcation lesions with 100％ success rate.All the procedure was transradial approach.Branch vascular dissection was found only in two cases (one with TIMI flow grade ＜ 2) and drug-eluting stents were used as the remedial measure.During perioperative and postoperative clinical visit (outpatient or telephone follow-up),no MCAE such as death or acute myocardial infarction (AMI) occurred.Angiographic follow-up was finished in 74.19％ of the patients.There was only one patient underwem target lesion revascularization (TLR).Late lumen loss (LLL) was (0.13 ± 0.25) mm.Condusions It is a safe and effective strategy to use DCB as a standalone procedure for side branch in patients with coronary bifurcation lesions.