Madhavan Mahesh V, Hakemi Emad, Neeranjun Rishi, Rahim Hussein M, Nouri Shayan Nabavi, Flattery Erin, Prasad Megha, Collins Michael B, Karmpaliotis Dimitri, Ali Ziad A, Parikh Sahil A, Vahl Torsten P, Patel Amisha, Nazif Tamim M, Fall Khady N, Maehara Akiko, Leon Martin B, Kirtane Ajay J, Moses Jeffrey W
Columbia University Irving Medical Center/NewYork-Presbyterian Hospital, New York, New York.
Cardiovascular Research Foundation, New York, New York.
J Soc Cardiovasc Angiogr Interv. 2024 Feb 20;3(3Part A):101262. doi: 10.1016/j.jscai.2023.101262. eCollection 2024 Mar.
While not available for clinical use in the United States, dedicated drug-coated balloons (DCB) are currently under investigation for the management of coronary in-stent restenosis (ISR). Peripheral drug-coated balloons (P-DCB) have been used off-label for coronary ISR. Further data regarding this practice are needed. We aimed to describe outcomes in patients who underwent off-label P-DCB angioplasty for coronary ISR.
We analyzed data on P-DCB angioplasty for coronary ISR at a single high-volume center between April 1, 2015, and December 30, 2017. Demographic and procedural details were collected, with systematic follow-up as clinically indicated.
Data from 31 patients treated with P-DCB angioplasty (mean age 68.0 ± 10.7 years) with coronary ISR (17 recurrent and 14 first time) were analyzed. Most patients presented with high-grade angina (81%) or myocardial infarction (13%). Treated ISR lesions were in native coronary arteries (68%), saphenous vein grafts (SVG, 23%), and the left internal mammary artery (10%). Diffuse intrastent ISR was common (69%) with a mean lesion length of 21.7 ± 12.4 mm. No postprocedural myocardial infarction occurred and 1 nonprocedural mortality occurred during index admission. At follow-up (median: 283, interquartile range [IQR]: 354 days), repeat angiography was performed in 19 patients (median: 212, IQR: 188 days), and 11 patients had target lesion recurrent ISR (Kaplan-Meier event-free survival estimate: 44.7%, 95% CI, 26.1%-76.5%).
In the absence of availability of dedicated coronary DCB, treatment of coronary ISR using P-DCB angioplasty was feasible, although follow-up demonstrated continued risk for recurrent ISR in this high-risk population.
虽然专用药物涂层球囊（DCB）在美国尚未用于临床，但目前正在研究其用于治疗冠状动脉支架内再狭窄（ISR）。外周药物涂层球囊（P-DCB）已被用于冠状动脉ISR的非标签治疗。需要更多关于这种做法的数据。我们旨在描述接受非标签P-DCB血管成形术治疗冠状动脉ISR患者的结局。
我们分析了2015年4月1日至2017年12月30日期间在一个高容量中心进行的冠状动脉ISR的P-DCB血管成形术的数据。收集了人口统计学和手术细节，并根据临床指征进行系统随访。
分析了31例接受P-DCB血管成形术治疗的冠状动脉ISR患者（平均年龄68.0±10.7岁）的数据（17例复发，14例首次发病）。大多数患者表现为重度心绞痛（81%）或心肌梗死（13%）。治疗的ISR病变位于冠状动脉（68%）、大隐静脉桥血管（SVG，23%）和左乳内动脉（10%）。弥漫性支架内ISR常见（69%），平均病变长度为21.7±12.4mm。术后无心肌梗死发生，住院期间发生1例非手术死亡。随访（中位数：283天，四分位间距[IQR]：354天）时，19例患者进行了重复血管造影（中位数：212天，IQR：188天），11例患者出现靶病变复发性ISR（Kaplan-Meier无事件生存率估计：44.7%，95%CI，26.1%-76.5%）。
在没有专用冠状动脉DCB的情况下，使用P-DCB血管成形术治疗冠状动脉ISR是可行的，尽管随访显示该高危人群中复发性ISR的风险持续存在。
