经皮切割球囊成形术治疗支架内再狭窄的研究

目的　研究切割球囊成形术对治疗支架内再狭窄的即刻和 6个月内随访效果。方法　 6 9例支架内再狭窄患者随机分配到切割球囊组 (38例 )和普通球囊治疗组 (31例 )。球囊扩张前及扩张后即刻在定量冠状动脉造影和冠状动脉内超声下 ,测定相关参数。观察随访 6个月内临床改善及冠状动脉造影结果。研究终点包括出现心肌梗死 ,需要冠状动脉搭桥或再介入治疗。结果　两组的手术成功率均为 10 0 %。切割球囊组 1例患者扩张后在支架的远端出现夹层。平均随访 (6 .7± 2 .3)个月。切割球囊组于术后 3和 6个月时的再狭窄率显著低于普通球囊组(15 %∶38%及 18%∶4 2 % ,P <0 .0 0 1)。扩张后即刻血管直径获得值在切割球囊组和普通球囊组分别为 (1.72±0 .5 2 )mm和 (1.15± 0 .5 4 )mm ,随访 3个月及随访终点时切割球囊组的血管直径晚期丢失分别为 (0 .2 6± 0 .0 5 )mm(3个月 )及 (0 .38± 0 .0 6 )mm ,同时的普通球囊组丢失值分别为 (0 .78± 0 .19)mm(3个月 )及 (0 .89± 0 .16 )mm。结论　切割球囊成形术治疗老年冠心病患者支架内狭窄效果可靠 ,安全 ,容易操作 ,再狭窄率低

Study of cutting balloon angioplasty for treatment of coronary artery in-stent restenosis in elderly patients

Objective To study the effect of cutting balloon angioplasty on immediate and 6 month outcomes of coronary artery in stent restenosis in elderly patients.Methods Sixty nine patients (average age>65 years old)with in stent restenosis were randomly divided into two groups:cutting balloon angioplasty group(38 cases) and conventional balloon angioplasty group(31 cases).Quantitative coronary angiography (QCA) and intravascular ultrasound(IVUS) were performed before and immediately after the balloon inflation.Results of 6 month clinical and angiographic follow up were recorded.Primary end points included myocardial infarction,need for coronary artery bypass graft(CABG) and revascularization.Results The success rate of the procedures was 100% in both groups.One patient in cutting balloon group experienced dissection at the site distal to stent.Average follow up time was 6.7±2.3 months.The restenosis rates at the 3rd and 6th month in cutting balloon group were markedly lower than those in conventional balloon group(15% and 38% vs 18% and 43%,repectively, P<0.001). The acute gain of vascular diameter in cutting balloon and conventional balloon group was 1.72±0.52 mm and 1.15±0.54 mm (P<0.01) respectively. The late loss of vascular diameter in cutting balloon group was 0.26±0.05 mm(at 3rd month) and 0.38±0.06 mm(at 6th month),and in conventional balloon group was 0.78±0.19 mm(at 3rd month)and 0.89±0.16 mm(at 6th month).Conventional balloon was difficult to fix onto the stent surface during inflation because of its slip,which was rare for cutting balloon.Conclusion Cutting balloon angioplasty is feasible and safe for the treatment of in stent restenosis in elderly patients.