Ge Jun-Bo, Chen Yun-Dai
J Geriatr Cardiol. 2024 Feb 28;21(2):135-152. doi: 10.26599/1671-5411.2024.02.001.
Percutaneous coronary interventions have progressed through the era of plain balloon dilation, bare-metal stent insertion to drug-eluting stent treatment, which has significantly reduced the acute occlusion and restenosis rates of target vessels and improved patient prognosis, making drug-eluting stents the mainstream interventional treatment for coronary artery disease. In recent years, drug-coated balloons (DCBs) have become a new treatment strategy for coronary artery disease, and the drugs used in the coating and the coating technology have progressed in the past years. Without permanent implant, a DCB delivers antiproliferative drugs rapidly and uniformly into the vessel wall via the excipient during a single balloon dilation. Many evidence suggests that DCB angioplasty is an effective measure for dealing with in-stent restenosis and lesions in small coronary vessels. As more clinical studies are published, new evidence is emerging for the use of DCB angioplasty in a wide range of coronary diseases, and the indications are expanding internationally. Based on the latest research from China and elsewhere, the Expert Writing Committee of the Chinese Expert Consensus on Clinical Applications of Drug-Coated Balloon has updated the previous DCB consensus after evidence-based discussions and meetings in terms of adequate preparation of in-stent restenosis lesions, expansion of the indications for coronary lesions, and precise guidance of DCB treatment by intravascular imaging and functional evaluation.
经皮冠状动脉介入治疗已经历了从单纯球囊扩张时代、裸金属支架植入到药物洗脱支架治疗的发展过程,药物洗脱支架显著降低了靶血管的急性闭塞和再狭窄率,改善了患者预后,成为冠状动脉疾病的主流介入治疗方法。近年来,药物涂层球囊(DCB)已成为冠状动脉疾病的一种新的治疗策略,过去几年中涂层所用药物及涂层技术都有了进展。DCB在单次球囊扩张过程中,无需永久性植入,可通过赋形剂将抗增殖药物快速、均匀地输送到血管壁。许多证据表明,DCB血管成形术是处理支架内再狭窄和冠状动脉小血管病变的有效措施。随着更多临床研究的发表,DCB血管成形术在广泛的冠状动脉疾病中的应用出现了新的证据,其适应证在国际上也不断扩大。基于中国和其他地区的最新研究,《药物涂层球囊临床应用中国专家共识》专家写作委员会在经过循证讨论和会议后,就支架内再狭窄病变的充分准备、冠状动脉病变适应证的扩展以及血管内成像和功能评估对DCB治疗的精准指导等方面,对之前的DCB共识进行了更新。