Du Xin, Wang Feng, Wu Dan-Ming, Zhang Min-Hong, Jia Xin, Zhang Ji-Wei, Zhuang Bai-Xi, Zhao Yu, Guo Ping-Fan, Bi Wei, Fu Wei-Guo, Guo Wei, Wang Shen-Ming
Chinese PLA General Hospital.
First Affiliated Hospital of Dalian Medical University.
Medicine (Baltimore). 2019 Mar;98(13):e14840. doi: 10.1097/MD.0000000000014840.
Atherosclerotic diseases may include femoropopliteal artery stenosis or occlusion. Percutaneous transluminal angioplasty (PTA) is an effective and minimally invasive treatment strategy for atherosclerotic femoropopliteal artery stenosis/occlusion disease. Balloon angioplasty is a widely used technique in the management of occlusive disease in almost all arterial segments.We enrolled 111 diabetics with long femoropopliteal lesions, among which 54 received PTA with paclitaxel-coated balloon (the Paclitaxel group), and 57 with standard balloon catheters (the Control group).The primary outcome was set as angiographic late lumen loss (LLL) within 6 months; the secondary angiographic outcome was binary restenosis. Clinical outcomes included Rutherford clarification, ankle-brachial index (ABI) and rate of clinically driven target lesion revascularization (TLR). Two groups had similar basal clinical features, angiographic and procedural characteristics. Compared to controls, the Paclitaxel group had a significantly lower 6-month LLL rate, 12-month binary restenosis rate, 12-month TLR, lower Rutherford grades at 3 and 6 months, and higher ABI at 3 months. For all factors which might influence outcomes, fasting blood glucose was negatively correlated with ABI; the blood urea nitrogen (BUN) was positively related with the Rutherford clarification grades. In addition, the coronary heart disease (CHD) and smoking histories were positively correlated with residual stenosis after treatment.Collectively, the paclitaxel-coated balloon angioplasty can yield more favorable angiographic and clinical outcomes than standard uncoated balloon angioplasty, even in the more challenging lesions (the long and occlusive femoropopliteal lesions) in diabetics, when it had a similar safety profile to the traditional balloon. Blood glucose, BUN, CHD, and smoking imply poor curative effects.
动脉粥样硬化疾病可能包括股腘动脉狭窄或闭塞。经皮腔内血管成形术（PTA）是治疗动脉粥样硬化性股腘动脉狭窄/闭塞性疾病的一种有效且微创的治疗策略。球囊血管成形术是在几乎所有动脉节段的闭塞性疾病管理中广泛使用的技术。我们纳入了111例患有长段股腘病变的糖尿病患者，其中54例接受了紫杉醇涂层球囊血管成形术（紫杉醇组），57例接受了标准球囊导管治疗（对照组）。主要结局设定为6个月内的血管造影晚期管腔丢失（LLL）；次要血管造影结局为二元再狭窄。临床结局包括卢瑟福分级、踝臂指数（ABI）以及临床驱动的靶病变血管重建率（TLR）。两组具有相似的基础临床特征、血管造影和手术特征。与对照组相比，紫杉醇组6个月的LLL率、12个月的二元再狭窄率、12个月的TLR显著更低，3个月和6个月时的卢瑟福分级更低，3个月时的ABI更高。对于所有可能影响结局的因素，空腹血糖与ABI呈负相关；血尿素氮（BUN）与卢瑟福分级呈正相关。此外，冠心病（CHD）和吸烟史与治疗后的残余狭窄呈正相关。总体而言，即使在糖尿病患者更具挑战性的病变（长段闭塞性股腘病变）中，紫杉醇涂层球囊血管成形术与传统球囊具有相似的安全性，但其血管造影和临床结局比标准未涂层球囊血管成形术更有利。血糖、BUN、CHD和吸烟提示疗效不佳。
