Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC.
J Am Coll Cardiol. 2020 Mar 10;75(9):1061-1073. doi: 10.1016/j.jacc.2019.12.046.
Percutaneous coronary intervention with a drug-eluting stent is the most common mode of revascularization for coronary artery disease. However, restenosis rates remain high. Non-stent-based local drug delivery by a drug-coated balloon (DCB) has been investigated, as it leaves no metallic mesh. A DCB consists of a semicompliant balloon coated with antiproliferative agents encapsulated in a polymer matrix, which is released into the wall after inflation and contact with the intima. DCB have demonstrated effectiveness in treating in-stent restenosis. Clinical studies using DCB in de novo coronary artery disease have shown mixed results, with a major benefit in small-vessel disease. Differences in study results are not only due to variations in DCB technology but also to disparity in procedural approach, "leave nothing behind" or "combination therapy," and vessel size. This review focuses on the available evidence from randomized trials and proposes a design for future clinical trials.
经皮冠状动脉介入治疗联合药物洗脱支架是治疗冠状动脉疾病最常用的血运重建方式。然而，再狭窄率仍然很高。非支架局部药物输送（药物涂层球囊，DCB）已被研究，因为它不留下金属网。DCB 由半顺应性球囊组成，球囊表面涂有包被在聚合物基质中的抗增殖药物，球囊充气并与内膜接触后，药物被释放到血管壁中。DCB 在治疗支架内再狭窄方面已被证明是有效的。在新发冠状动脉疾病中使用 DCB 的临床研究结果不一，在小血管疾病中获益较大。研究结果的差异不仅归因于 DCB 技术的差异，还归因于操作方法的差异，如“无遗留”或“联合治疗”以及血管大小的差异。本综述重点介绍了随机试验的现有证据，并为未来的临床试验提出了设计方案。
