Cin Veli Gokhan, Pekdemir Hasan, Akkus Mehmet Necdet, Camsari Ahmet, Doven Oben, Yenihan Senay
Department of Cardiology, Mersin University School of Medicine, Mersin, Turkey.
Angiology. 2006 Aug-Sep;57(4):445-52. doi: 10.1177/0003319706290619.
Ranging from 24% to 55%, angiographic in-stent restenosis (ISR) rates in diabetics are higher than the 17% to 28% rates observed in nondiabetics. There are controversies regarding optimal treatment for ISR. Recently, cutting balloon angioplasty (CBA) emerged as a tool in management. The authors assessed the hypothesis that CBA has advantages over conventional percutaneous transluminal balloon angioplasty (PTCA) in treatment of ISR in diabetics. CBA or PTCA was applied to 165 diabetics (267 ISR lesions) in their institution. With a computer algorithm, an attempt was made to match each lesion in the CBA group with a corresponding lesion in the PTCA group. The lesion pairs should match with respect to the patients' age and gender, type of target vessel and stent, reference vessel diameter, and baseline minimal lumen diameter (MLD). Following the matching process, 55 ISR lesion pairs were identified. Baseline patient characteristics were similar among the groups (p = NS). There was no difference in the in-hospital major adverse cardiac events (MACE) between the groups, whereas MACE at follow up was significantly lower in the CBA group compared to the PTCA group (CBA, 20.0% vs PTCA, 43.6%, p<0.05). The recurrent ISR rate was significantly lower in the CBA group compared to the PTCA group (CBA, 27.3% vs PTCA, 49.1%; p < 0.05). Also, a diffuse pattern of recurrence was more common in lesions treated with PTCA, whereas a focal pattern of recurrence was more common in the CBA group. The minimal luminal diameter at follow-up, the acute gain, and net gain were significantly higher in the group of lesions treated with CBA than in the PTCA group. In addition, a significantly higher late loss and loss index at follow-up were observed in the PTCA group compared to the CBA group. CBA has advantages over PTCA in treatment of diabetic patients with ISR, with better immediate and follow-up angiographic outcomes, and better follow-up clinical outcome.
糖尿病患者的血管造影支架内再狭窄（ISR）率在24%至55%之间，高于非糖尿病患者中观察到的17%至28%的比率。关于ISR的最佳治疗方法存在争议。最近，切割球囊血管成形术（CBA）成为一种治疗手段。作者评估了CBA在治疗糖尿病患者ISR方面优于传统经皮腔内球囊血管成形术（PTCA）的假设。在他们的机构中，对165名糖尿病患者（267个ISR病变）进行了CBA或PTCA治疗。通过计算机算法，试图将CBA组中的每个病变与PTCA组中的相应病变进行匹配。病变对应在患者的年龄和性别、靶血管和支架类型、参考血管直径以及基线最小管腔直径（MLD）方面相匹配。经过匹配过程，确定了55对ISR病变。各组之间的基线患者特征相似（p =无显著性差异）。两组之间的院内主要不良心脏事件（MACE）无差异，而与PTCA组相比，CBA组随访时的MACE显著更低（CBA，20.0%对PTCA，43.6%，p<0.05）。与PTCA组相比，CBA组的复发性ISR率显著更低（CBA，27.3%对PTCA，49.1%；p < 0.05）。此外，PTCA治疗的病变中弥漫性复发模式更常见，而CBA组中局灶性复发模式更常见。CBA治疗的病变组随访时的最小管腔直径、急性增益和净增益显著高于PTCA组。此外，与CBA组相比，PTCA组随访时观察到显著更高的晚期丢失和丢失指数。在治疗糖尿病ISR患者方面，CBA优于PTCA，具有更好的即刻和随访血管造影结果以及更好的随访临床结果。
