Mohiaddin Hasan, Wong Tamar D F K, Burke-Gaffney Anne, Bogle Richard G
Faculty of Medicine, Imperial College London, London, UK.
Vascular Biology, National Heart & Lung Institute (NHLI), Faculty of Medicine, Imperial College London, London, UK.
Cardiol Ther. 2018 Dec;7(2):127-149. doi: 10.1007/s40119-018-0121-2. Epub 2018 Oct 27.
Percutaneous coronary intervention (PCI) with a drug coated balloon (DCB) is a novel treatment which seeks to acutely dilate a coronary stenosis and deliver an anti-proliferative drug to the vessel wall (reducing the risk of re-stenosis), without implanting a drug eluting stent (DES). In this study, we performed a systematic review of stentless DCB-only angioplasty in de novo coronary artery disease. We identified 41 studies examining the effects of DCB-only PCI in a variety of clinical scenarios including small vessels, bifurcations, calcified lesions, and primary PCI. DCB-only PCI appears to be associated with comparable clinical outcomes to DESs and superior angiographic outcomes to plain-old balloon angioplasty. Although current data are promising, there is still a need for further long-term randomized control trial data comparing a DCB-only approach specifically against a second- or third-generation DES. A 4-week period of dual antiplatelet therapy provides a real advantage for the DCB-only PCI approach, which is not possible with most DESs. Since rates of adverse clinical outcomes are very low for all PCI procedures attention should be turned to the development of robust endpoints with which to compare DCB-only PCI approaches to the standard treatment with a DES.
使用药物涂层球囊（DCB）的经皮冠状动脉介入治疗（PCI）是一种新型治疗方法，旨在急性扩张冠状动脉狭窄并将抗增殖药物输送至血管壁（降低再狭窄风险），而无需植入药物洗脱支架（DES）。在本研究中，我们对初发冠状动脉疾病中仅使用无支架DCB的血管成形术进行了系统评价。我们确定了41项研究，这些研究考察了仅使用DCB的PCI在包括小血管、分叉病变、钙化病变和直接PCI在内的各种临床情况下的效果。仅使用DCB的PCI似乎与DES具有相当的临床结局，并且在血管造影结果方面优于普通球囊血管成形术。尽管目前的数据很有前景，但仍需要进一步的长期随机对照试验数据，以专门比较仅使用DCB的方法与第二代或第三代DES。为期4周的双联抗血小板治疗为仅使用DCB的PCI方法提供了真正的优势，而这对于大多数DES来说是不可能的。由于所有PCI手术的不良临床结局发生率都非常低，因此应关注开发有力的终点指标，以便将仅使用DCB的PCI方法与使用DES的标准治疗进行比较。
