Charité Universitätsmedizin Berlin, Berlin, Germany.
Clin Res Cardiol. 2014 Jun;103(6):451-6. doi: 10.1007/s00392-014-0671-9. Epub 2014 Feb 14.
This observational study investigated the value of drug-coated balloons (DCB) only strategy in bifurcation lesions in a consecutive series of all comer percutaneous coronary intervention.
Local application of paclitaxcel by DCB has clinical benefits in various settings including coronary bifurcations. While so far most bifurcation studies investigated sequential application of DCBs to the main (MB) and side branch (SB) with stenting of the MB, we report first results after DCB intervention without additional stenting of the MB or SB.
We performed 39 consecutive DCB only interventions in de novo bifurcation lesions with SB ≥ 2 mm and scheduled follow-up angiography after 4 months. Patients refusing angiography had telephone follow-up.
Follow-up angiograms were obtained in 30 out of 39 DCB only interventions. 33.3 % were located in the left main (LM) bifurcation, 28.2 % in left anterior descending (LAD), 20.5 % in left circumflex (LCX) and 17.9 % in the right coronary artery. Four months after index procedure no patient had died, experienced myocardial infarction or stroke. Follow-up angiograms showed restenosis in 3 out of 30 interventions (10 %), 2 developing in the distal main (6.7 %) and 1 in the SB (3.3 %). All three patients had been treated for LM/LAD/LCX bifurcations and suffered from most severe coronary artery disease, but had not been eligible for CABG for various reasons. Target lesion revascularization was performed in 3 out of 39 patients consistent with a MACE rate of 7.7 %.
Treatment of de novo bifurcation lesions with DCB only intervention without additional stenting is a safe therapy with low rates of restenosis and TLR.
本观察性研究旨在探讨药物涂层球囊（DCB）在所有经皮冠状动脉介入治疗（PCI）患者的分叉病变中的应用价值。
在包括冠状动脉分叉病变在内的多种情况下，局部应用紫杉醇的 DCB 具有临床获益。尽管到目前为止，大多数分叉病变研究都调查了 DCB 序贯应用于主支（MB）和侧支（SB），并对 MB 进行支架置入，但我们首次报告了不进行 MB 或 SB 额外支架置入，仅进行 DCB 干预的结果。
我们对 SB≥2mm 的新发分叉病变进行了 39 例连续的 DCB 单支介入治疗，在 4 个月后进行随访造影。拒绝造影的患者进行了电话随访。
在 39 例 DCB 单支介入治疗中，30 例获得了随访造影。33.3%位于左主干（LM）分叉处，28.2%位于左前降支（LAD），20.5%位于左回旋支（LCX），17.9%位于右冠状动脉。指数操作后 4 个月内，无患者死亡、发生心肌梗死或卒中。随访造影显示 30 例中有 3 例（10%）出现再狭窄，2 例（6.7%）发生在主支远端，1 例（3.3%）发生在 SB。这 3 例患者均接受了 LM/LAD/LCX 分叉病变治疗，且患有最严重的冠心病，但由于各种原因不符合 CABG 适应证。39 例患者中有 3 例（7.7%）进行了靶病变血运重建，主要不良心脏事件（MACE）发生率为 7.7%。
对于新发分叉病变，仅采用 DCB 介入治疗而不进行额外支架置入是一种安全的治疗方法，其再狭窄和 TLR 发生率较低。
