Department of Cardiology, Tokeidai Memorial Hospital, Hokkaido, Japan.
Department of Cardiovascular Medicine, Toyohashi Heart Center, Aichi, Japan.
Catheter Cardiovasc Interv. 2021 Apr 1;97(5):E614-E623. doi: 10.1002/ccd.29185. Epub 2020 Aug 10.
To evaluate the efficacy and safety of additional drug-coated balloon (DCB) angioplasty after directional coronary atherectomy (DCA) for coronary bifurcation lesions.
The optimal therapy for bifurcation lesions has not been established, even in the drug-eluting stent era. DCA possibly prevents plaque and carina shift in bifurcation lesions by plaque debulking; however, the efficacy of combined DCA and DCB (DCA/DCB) for bifurcation lesions remains unclear.
This multicenter registry retrospectively recruited patients with bifurcation lesions who underwent DCA/DCB and follow-up angiogram at 6-15 months. The primary endpoint was the 12-month target vessel failure (TVF) rate. The secondary endpoints were procedure-related major complications, major cardiovascular events at 12 months, restenosis at 12 months, target lesion revascularization (TLR) at 12 months, and target vessel revascularization (TVR) at 12 months.
We enrolled 129 patients from 16 Japanese centers. One hundred and four lesions (80.6%) were located around the left main trunk bifurcations. No side branch compromise was found intraoperatively. Restenosis was observed in three patients (2.3%) at 12 months. TLR occurred in four patients (3.1%): 3 (2.3%) in the main vessel and 1 (0.8%) in the ostium of the side branch at 12 months. TVF incidence at 12 months was slightly higher in 14 patients (10.9%), and only two patients (1.6%) had symptomatic TVR. One patient (0.8%) had non-target vessel-related myocardial infarction.
Our data suggested that DCA/DCB provided good clinical outcomes and minimal side branch damage and could be an optimal non-stent percutaneous coronary intervention strategy for bifurcation lesions.
评估在经皮冠状动脉腔内血管成形术（DCA）后行药物涂层球囊（DCB）血管成形术治疗冠状动脉分叉病变的疗效和安全性。
即使在药物洗脱支架时代，分叉病变的最佳治疗方法仍未确定。DCA 通过斑块切除术可能防止分叉病变中的斑块和嵴移位；然而，联合 DCA 和 DCB（DCA/DCB）治疗分叉病变的疗效尚不清楚。
这项多中心回顾性研究招募了在 6-15 个月内行 DCA/DCB 及随访血管造影的分叉病变患者。主要终点是 12 个月时的靶血管失败（TVF）率。次要终点是与操作相关的主要并发症、12 个月时的主要心血管事件、12 个月时的再狭窄、12 个月时的靶病变血运重建（TLR）和 12 个月时的靶血管血运重建（TVR）。
我们从 16 个日本中心纳入了 129 名患者。104 处病变（80.6%）位于左主干分叉处周围。术中未发现侧支血管受累。12 个月时，3 名患者（2.3%）出现再狭窄。12 个月时，4 名患者（3.1%）发生 TLR：主血管 3 例（2.3%），侧支开口 1 例（0.8%）。12 个月时 TVF 发生率略高，14 名患者（10.9%），仅有 2 名患者（1.6%）出现症状性 TVR。1 名患者（0.8%）发生非靶血管相关心肌梗死。
我们的数据表明，DCA/DCB 提供了良好的临床结果和最小的侧支损伤，可能是分叉病变的一种最佳非支架经皮冠状动脉介入治疗策略。
