Zhang Hui-Ping, Yu Xue, Ji Fu-Sui, Sun Fu-Cheng
Department of Cardiology, Beijing Hospital, National Center of Gerontology, Dong Dan, Beijing, China.
Medicine (Baltimore). 2018 Nov;97(45):e13208. doi: 10.1097/MD.0000000000013208.
The safety and efficacy of drug-coated balloon (DCB) technology have primarily been proven in the treatment of coronary in-stent restenosis. Whereas increasing evidences show that DCB use was feasible in certain de novo coronary lesions. In 2012, Vassilev reported the 1st case in which a coronary aneurysm formed after a DCB was used to treat drug-eluting stent (DES) restenosis. To date, limited information has been reported on coronary artery aneurysm (CAA) development following DCB treatment of de novo lesions.
A 42-year-old male underwent delayed coronary angiography due to extensive anterior wall myocardial infarction. After balloon predilation in the mid-left anterior descending (LAD) artery, the residual 30% stenosis without major dissection was treated with a DCB. Angiographic follow-up at 6 and 12 months revealed an aneurysm in the treated area of the LAD artery, with positive vascular remodeling behind this aneurysm. A 54-year-old male with nonstent thrombosis elevation myocardial infarction underwent elective catheterization. Coronary angiography revealed critical stenosis in the LAD and significant narrowing at the distal segments of both the left circumflex artery (LCX) and the nondominant right coronary artery. After predilation of the lesion in the LCX, the residual 30% stenosis was treated with a DCB. The lesion in the LAD was treated with a DCB either. Angiography follow-up at 6 months revealed good results in the LAD; however, an aneurysm was observed in the DCB-treated area of the LCX.
The CAA formation after DCB treatment of de novo lesions.
Because the 2 patients were asymptomatic upon diagnosis, the aneurysms were left untreated. Long-term dual antiplatelet therapy and intense follow-up were recommended.
Our cases raise questions regarding the safety of DCB treatment for de novo lesions in real-world contexts. There might be a need to clarify the appropriate doses for drugs coated on DCBs. Although indications for DCB treatment for de novo coronary lesions should not be overly aggressively broadened, the potential role of such treatment in this context merits additional elucidation in future studies.
药物涂层球囊（DCB）技术的安全性和有效性主要在冠状动脉支架内再狭窄的治疗中得到证实。然而，越来越多的证据表明，DCB在某些原发性冠状动脉病变中的应用是可行的。2012年，瓦西列夫报告了首例使用DCB治疗药物洗脱支架（DES）再狭窄后形成冠状动脉瘤的病例。迄今为止，关于DCB治疗原发性病变后冠状动脉瘤（CAA）发生情况的报道有限。
一名42岁男性因广泛前壁心肌梗死接受延迟冠状动脉造影。在左前降支（LAD）中段进行球囊预扩张后，对残余30%狭窄且无严重夹层的病变使用DCB进行治疗。6个月和12个月的血管造影随访显示，LAD动脉治疗区域出现动脉瘤，该动脉瘤后方血管重塑呈阳性。一名54岁男性因非支架血栓性抬高型心肌梗死接受择期导管插入术。冠状动脉造影显示LAD严重狭窄，左旋支（LCX）和非优势右冠状动脉远端节段明显狭窄。对LCX病变进行预扩张后，对残余30%狭窄使用DCB进行治疗。LAD病变也使用DCB进行治疗。6个月的血管造影随访显示LAD效果良好；然而，在LCX的DCB治疗区域观察到一个动脉瘤。
DCB治疗原发性病变后CAA形成。
由于两名患者诊断时无症状，动脉瘤未予治疗。建议进行长期双联抗血小板治疗并密切随访。
我们的病例引发了关于DCB在现实世界中治疗原发性病变安全性的问题。可能需要明确DCB上涂层药物的合适剂量。虽然不应过度积极地扩大DCB治疗原发性冠状动脉病变的适应证，但这种治疗在这种情况下潜在的作用值得在未来研究中进一步阐明。
