Turbo-Power™ 激光动脉切除术联合药物涂层球囊血管成形术治疗 Tosaka II 和 III 型股腘动脉支架内再狭窄的一年随访结果改善。
Turbo-Power™ Laser Atherectomy Combined with Drug-coated Balloon Angioplasty is Associated with Improved One-Year Outcomes for the Treatment of Tosaka II and III Femoropopliteal In-stent Restenosis.
机构信息
Division of Cardiology, Rocky Mountain Regional VA Medical Center, University of Colorado, Denver, CO, USA.
Division of Cardiovascular Medicine, University of California, Davis, CA, USA.
出版信息
Cardiovasc Revasc Med. 2020 Jun;21(6):771-778. doi: 10.1016/j.carrev.2019.10.006. Epub 2019 Oct 18.
BACKGROUND
Femoropopliteal (FP) artery in-stent restenosis (ISR) is associated with high rates of re-intervention and occlusion. The combined use of laser atherectomy (LA) with balloon angioplasty (BA) is superior to conventional balloon angioplasty (BA). Drug-coated balloons (DCBs) when combined with LA have provided additional efficacy for the treatment of FP-ISR. The aim of this study was to investigate the combination of DCB + LA with the recently approved Turbo-Power™ (Spectranetics Inc., Colorado Springs, CO, USA) LA device.
METHODS
This was a dual-center retrospective study enrolling 78 consecutive patients with Tosaka type II (n = 18) or III (n = 60) FP-ISR. The lesions were treated with either Turbo-Power™ LA followed by DCB (n = 27) or with other LA devices followed by plain BA (LA + BA; n = 51) from 2015 to 2017. A Cox regression analysis was performed to examine the association between the two groups in terms of target lesion revascularization (TLR) and occlusion rates over a follow up period of 12 months. Kaplan-Meier survival curves were estimated and compared with the log-rank test.
RESULTS
The overall procedural success was 90%. Eight periprocedural complications occurred without any difference between the two groups (Turbo-Power™ + DCB: 7.4% vs LA + BA: 11.8%, p = .7). The 12-month KM estimates for freedom from TLR were 90.9% in the Turbo-Power™ + DCB group vs 55.7% in the LA + BA group (p = .005). Among Toasaka III lesions, the 12 m-KM survival estimates for freedom from TLR were 88.9% in the Turbo-Power™ + DCB group vs 54.2% in the LA + BA group (p = .009). The 12 m-KM estimates for freedom from re-occlusion were 89.0% in the Turbo-Power™ + DCB group vs 58.9% in the LA + BA group (p = .070).
CONCLUSIONS
Turbo-Power™ laser atherectomy combined with DCB exerted synergistic mechanism of actions and improved 12-month TLR rates for the treatment of complex FP-ISR lesions.
背景
股浅动脉（FP）支架内再狭窄（ISR）与高再介入和闭塞率相关。激光动脉切除术（LA）联合球囊血管成形术（BA）的联合应用优于传统的球囊血管成形术（BA）。当与 LA 联合使用时，药物涂层球囊（DCB）为治疗 FP-ISR 提供了额外的疗效。本研究的目的是研究最近批准的 Turbo-Power ™（Spectranetics Inc.，科罗拉多斯普林斯，CO，美国）LA 装置与 DCB+LA 的联合应用。
方法
这是一项回顾性的双中心研究，共纳入 78 例 Tosaka Ⅱ型（n=18）或Ⅲ型（n=60）FP-ISR 连续患者。这些病变分别采用 Turbo-Power ™ LA 联合 DCB（n=27）或其他 LA 装置联合普通 BA（LA+BA；n=51）进行治疗，治疗时间为 2015 年至 2017 年。采用 Cox 回归分析，比较两组患者在 12 个月随访期间靶病变血运重建（TLR）和闭塞率的相关性。通过 Kaplan-Meier 生存曲线估计，并采用对数秩检验进行比较。
结果
总体手术成功率为 90%。两组间无明显差异（Turbo-Power ™+DCB：7.4% vs LA+BA：11.8%，p=0.7）。在 Turbo-Power ™+DCB 组中，12 个月时 TLR 无事件生存率为 90.9%，在 LA+BA 组中为 55.7%（p=0.005）。在 Tosaka Ⅲ型病变中，在 Turbo-Power ™+DCB 组中，12 个月时 TLR 无事件生存率为 88.9%，在 LA+BA 组中为 54.2%（p=0.009）。在 Turbo-Power ™+DCB 组中，12 个月时无再闭塞事件生存率为 89.0%，在 LA+BA 组中为 58.9%（p=0.070）。
结论
Turbo-Power ™激光动脉切除术联合 DCB 发挥了协同作用，提高了治疗复杂 FP-ISR 病变的 12 个月 TLR 率。
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