Funatsu Atsushi, Kobayashi Tomoko, Mizobuchi Masahiro, Nakamura Shigeru
Cardiovascular Center, Kyoto Katsura Hospital, 17 Yamada hirao-cho, Nishikyo-ku, Kyoto, 615-8256, Japan.
Cardiovasc Interv Ther. 2019 Oct;34(4):317-324. doi: 10.1007/s12928-019-00571-3. Epub 2019 Jan 16.
The mechanism of how angiographic results following paclitaxel-coated balloon (PCB) treatment for small vessel disease affect patient outcome remains unknown. In the present study, we aimed to investigate the correlation between coronary dissection immediately after PCB angioplasty and midterm outcome. From March 2014 to March 2017, 171 consecutive patients with 228 native coronary artery lesions who received PCB angioplasty at a single center were enrolled retrospectively. Lesions with a reference vessel diameter > 2.8 mm were excluded. There were dissections in 80% of the lesions immediately following PCB angioplasty. Of these, 38% were type A, 29% were type B, and 13% were type C or more severe dissection. No patient required revascularization during hospitalization. We were able to follow 159 patients (212 lesions) clinically for > 6 months, from among whom target lesion revascularization (TLR) was performed in 7% of the patients. Follow-up angiography was performed on 143 lesions (67%), and complete healing of all dissections was noted. The rates of restenosis and late lumen enlargement were 12% and 56%, respectively. Multivariate analysis identified that a bending lesion was an independent predictor of TLR, and type C-E dissection and imaging device use were independent predictors of restenosis. Conversely, lesions with type B dissection had a larger net gain than lesions with type A or no dissection. Leaving the dissection uncovered after PCB angioplasty seems to be safe, resulting in a low acute event rate. The type B dissection after PCB angioplasty was the most therapeutic dissection.
紫杉醇涂层球囊（PCB）治疗小血管疾病后的血管造影结果如何影响患者预后的机制尚不清楚。在本研究中，我们旨在探讨PCB血管成形术后即刻发生的冠状动脉夹层与中期预后之间的相关性。2014年3月至2017年3月，对在单一中心接受PCB血管成形术的171例连续患者的228处原发性冠状动脉病变进行回顾性研究。排除参考血管直径>2.8mm的病变。PCB血管成形术后即刻，80%的病变发生夹层。其中，38%为A型，29%为B型，13%为C型或更严重的夹层。住院期间无患者需要血运重建。我们能够对159例患者（212处病变）进行>6个月的临床随访，其中7%的患者进行了靶病变血运重建（TLR）。对143处病变（67%）进行了随访血管造影，所有夹层均完全愈合。再狭窄率和晚期管腔扩大率分别为12%和56%。多因素分析确定，弯曲病变是TLR的独立预测因素，C-E型夹层和成像设备的使用是再狭窄的独立预测因素。相反，B型夹层病变的净增益大于A型或无夹层病变。PCB血管成形术后不覆盖夹层似乎是安全的，急性事件发生率较低。PCB血管成形术后的B型夹层是最具治疗意义的夹层。
