经皮切割球囊成形术治疗支架内再狭窄的研究

目的 :研究切割球囊对支架内再狭窄的即刻和 6个月内随访效果。方法 :69例支架内再狭窄患者随机分为切割球囊 (3 8例 )和普通球囊治疗组 (3 1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。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 :2组的手术成功率为 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 %、3 8%及 18%、43 % ,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 2mm和 1 15± 0 5 4mm ,而随访终点时切割球囊组的血管直径晚期丢失为 0 2 6± 0 0 5mm (3个月 )及 0 3 8± 0 0 6mm ,同时的普通球囊组丢失值为 0 78± 0 19mm(3个月 )及 0 89± 0 16mm。对于支架体部狭窄 ,普通球囊难以固定 ,扩张时移动明显 ,而切割球囊较易于固定 ,扩张时罕见移动。结论 :切割球囊治疗老年冠心病患者支架内再狭窄效果可靠 ,安全 ,容易操作。再狭窄率低 ,手术费用相对易于患者接受 ,是一个较有前途的治疗手段

STUDY OF CUTTING BALLOON ANGIOPLASTY FOR CORONARY ARTERY IN-STENT RESTENOSIS IN ELDERLY PATIENTS

Objective:To study the effect of cutting balloon angioplasty on immediate and 6-months outcomes for coronary artery in-stent restenosis in elderly patients.Methods:69 patients (average age >65 years old)with in-stent restenosis were randomizedly divided into two groups:cutting balloon(38 cases) and conventional balloon angioplasty(31 cases) group. Quantitative coronary angiography(QCA)and intravascular ultrasound(IVUS) were underwent before and immediately after the balloon inflation.Within 6-months clinical and angiographic follow-up were recorded.Primary end points included myocardial infarction, coronary artery bypass graft(CABG) and revascularization.Results:The procedural success rate was 100% in both groups.One patient in cutting balloop experienced dissection in the site distal to stent.Average follow-up time was 6.7±2.3 months.The angiographic stenosis rates at the 3- and 6-month in cutting balloon group were markedly lower than that in conventional balloon group(15% and 18% vs 18% and 43%,repectivelly,P<0 001).The acute gain in cutting balloon and conventional group was 1 72±0 52mm and 1 15±0 54mm(P<0 01).The late loss in cutting balloon group were 0 26±0 05mm(at 3-month) and 0 38±0 06mm(at 6-month),and was 0 78±0 19mm(at 3-month) and 0 89±0 16mm(at-6month).Conventional balloon was difficult to fix onto the stent surface during inflation because of its sleepy,which was rare for cutting balloon.Conclusions:Cutting balloon angioplasty is feasible and safe for the treatment of in-stent restenosis in elderly patients with the technical demanding.