Division of Cardiology, Saint Alphonsus Health System, Boise, Idaho, USA.
Heart, Vascular, and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA; Cleveland Clinic Lerner Research Institute, Quantitative Health Sciences, Cleveland, Ohio, USA.
JACC Clin Electrophysiol. 2024 Aug;10(8):1840-1847. doi: 10.1016/j.jacep.2024.04.020. Epub 2024 Jun 19.
Current therapies for pulmonary vein stenosis (PVS) or pulmonary vein total occlusion (PVTO) involving angioplasty and stenting are hindered by high rates of restenosis.
This study compares a novel approach of drug-coated balloon (DCB) angioplasty and stenting with the current standard of care in PVS or PVTO due to pulmonary vein isolation (PVI).
A retrospective single-center study analyzed patients with PVS or PVTO due to PVI who underwent either angioplasty and stenting (NoDCB group; December 2012-December 2016) or DCB angioplasty and stenting (DCB group; January 2018-January 2021). Multivariable Andersen-Gill regression analysis assessed the risk of restenosis and target lesion revascularization (TLR).
The NoDCB group comprised 58 patients and 89 veins, with a longer median follow-up of 35 months, whereas the DCB group included 26 patients and 33 veins, with a median follow-up of 11 months. The DCB group exhibited more PVTO (NoDCB: 12.3%; DCB: 42.4%; P = 0.0001), with a smaller reference vessel size (NoDCB: 10.2 mm; DCB: 8.4 mm; P = 0.0004). Follow-up computed tomography was performed in 82% of NoDCB and 85% of DCB, revealing lower unadjusted rates of restenosis (NoDCB: 26%; DCB: 14.3%) and TLR (NoDCB: 34.2%; DCB: 10.7%) in the DCB group. DCB use was associated with a significantly lower risk of restenosis and TLR (HR: 0.003: CI: 0.00009-0.118; P = 0.002).
The novel approach of DCB angioplasty followed by stenting is effective and safe and significantly reduces the risk of restenosis and reintervention compared with the standard of care in PVS or PVTO due to PVI.
目前，经皮腔内血管成形术和支架置入术治疗肺静脉狭窄（PVS）或肺静脉完全闭塞（PVTO）的方法受到再狭窄率高的限制。
本研究比较了一种新的药物涂层球囊（DCB）血管成形术和支架置入术与肺静脉隔离（PVI）后 PVS 或 PVTO 的标准治疗方法。
一项回顾性单中心研究分析了接受经皮腔内血管成形术和支架置入术（无 DCB 组；2012 年 12 月至 2016 年 12 月）或 DCB 血管成形术和支架置入术（DCB 组；2018 年 1 月至 2021 年 1 月）的 PVS 或 PVTO 患者。多变量 Andersen-Gill 回归分析评估了再狭窄和靶病变血运重建（TLR）的风险。
无 DCB 组包括 58 例患者 89 支静脉，中位随访时间较长，为 35 个月，而 DCB 组包括 26 例患者 33 支静脉，中位随访时间为 11 个月。DCB 组表现出更多的 PVTO（无 DCB：12.3%；DCB：42.4%；P=0.0001），参考血管直径更小（无 DCB：10.2mm；DCB：8.4mm；P=0.0004）。82%的无 DCB 组和 85%的 DCB 组进行了随访 CT，结果显示 DCB 组无再狭窄（无 DCB：26%；DCB：14.3%）和 TLR（无 DCB：34.2%；DCB：10.7%）的未调整率较低。DCB 的使用与再狭窄和 TLR 的风险显著降低相关（HR：0.003；CI：0.00009-0.118；P=0.002）。
与 PVI 后 PVS 或 PVTO 的标准治疗方法相比，新型 DCB 血管成形术加支架置入术的方法有效且安全，并显著降低了再狭窄和再干预的风险。
