切割球囊血管成形术治疗弥漫性支架内再狭窄的疗效

The impact of cutting balloon angioplasty for the treatment of diffuse in-stent restenosis.

作者信息

Iijima Raisuke, Ikari Yuji, Anzai Hitoshi, Nishida Takahiro, Tsunoda Taro, Nakamura Masato, Hara Kazuhiro, Yamaguchi Tetsu

机构信息

Division of Cardiology, Mitsui Memorial Hospital, 1 Kanda-Izumicho Chiyoda-ku, Tokyo, 101-8643, Japan.

出版信息

J Invasive Cardiol. 2003 Aug;15(8):427-31.

PMID:12890868

Abstract

OBJECTIVE

To determine the comparable safety and efficacy of cutting balloon angioplasty (CBA) and balloon angioplasty (BA) for diffuse in-stent restenosis (ISR).

BACKGROUND

Previous studies have found that diffuse-type ISR predicts recurrence of ISR. The efficacy of CBA in this clinical setting is incompletely documented.

METHODS AND RESULTS

One-hundred and seven consecutive diffuse ISR lesions (length > 10 mm) in 104 patients treated by CBA or BA were retrospectively analyzed. CBA was used in 61 lesions and BA in 46 lesions. Initial success (residual restenosis 30% with no major complications) was achieved in 99% of cases in each group. Follow-up angiography was performed in all patients at 131 93 days. Although the percent diameter stenosis after CBA was lower than after BA (19 12% versus 27 12%; p = 0.001), intravascular ultrasound (IVUS) or other QCA data were similar in the 2 groups. In follow-up angiography, recurrent restenosis rate was not statistically different between CBA (34%) and BA (52%); however, recurrent diffuse ISR was lower in the CBA group (20%) than the BA group (48%; p = 0.01). Lesion length at follow-up in the CBA group was smaller compared to the BA group (15.9 7.3 mm versus 24.2 14.4 mm; p < 0.05), while lesion length before procedure was similar.

CONCLUSION

CBA for ISR is safe and effective with favorable long-term outcomes. This effect is mainly due to shortening lesion length.

摘要

目的

确定切割球囊血管成形术（CBA）与球囊血管成形术（BA）治疗弥漫性支架内再狭窄（ISR）的安全性和疗效的可比性。

背景

既往研究发现弥漫型ISR预示着ISR的复发。CBA在这种临床情况下的疗效记录不完整。

方法与结果

回顾性分析104例接受CBA或BA治疗的患者中连续的107处弥漫性ISR病变（长度>10mm）。61处病变采用CBA，46处病变采用BA。每组99%的病例取得了初始成功（残余再狭窄<30%且无重大并发症）。所有患者在131±93天进行了随访血管造影。虽然CBA术后直径狭窄百分比低于BA（19±12%对27±12%；p = 0.001），但两组的血管内超声（IVUS）或其他定量冠状动脉造影（QCA）数据相似。在随访血管造影中，CBA组（34%）和BA组（52%）的再狭窄复发率无统计学差异；然而，CBA组的弥漫性ISR复发率（20%）低于BA组（48%；p = 0.01）。与BA组相比，CBA组随访时的病变长度更小（15.9±7.3mm对24.2±14.4mm；p<0.05），而术前病变长度相似。