Gitto Mauro, Leone Pier Pasquale, Gioia Francesco, Chiarito Mauro, Latini Alessia, Tartaglia Francesco, Kilic Ismail Dogu, Rossi Marco Luciano, Regazzoli Damiano, Gasparini Gabriele, Cozzi Ottavia, Sticchi Alessandro, Condorelli Gianluigi, Reimers Bernhard, Stefanini Giulio, Mangieri Antonio, Colombo Antonio
Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy; Mount Sinai Fuster Heart Hospital, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
Department of Biomedical Sciences; Humanitas University; Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano-Milan, Italy.
Am J Cardiol. 2025 Mar 15;239:28-35. doi: 10.1016/j.amjcard.2024.12.008. Epub 2024 Dec 10.
Coronary dissection is a potential occurrence after lesion preparation for percutaneous coronary intervention (PCI). Unlike stents, drug-coated balloons (DCBs) do not allow to cover dissections, thus demanding an assessment of their safety in this setting. This study aimed to evaluate the incidence, predictors, and clinical outcomes of dissections occurring with DCB-based PCI for de novo coronary artery disease. Consecutive patients with de novo coronary artery disease who underwent PCI with intention-to-treat DCB angioplasty, with or without stent implantation, were retrospectively enrolled between 2018 and 2022 at 2 Italian centers. The decision whether to leave a dissection untreated or to proceed with bail-out stenting was based on a combined angiographic evaluation of Thrombolysis In Myocardial Infarction flow, residual minimal lumen diameter, and persistent extraluminal contrast hang-up. The primary end point at 2-year follow-up was target lesion failure, a composite of cardiac death, target vessel myocardial infarction, and clinically driven target lesion revascularization. Among 522 DCB-treated lesions (466 patients), dissections were angiographically evident in 39.1% of cases, with 21.1% which underwent bail-out stenting and 78.9% left untreated. The incidence of bail-out stenting increased from type A to type E dissections (p for trend <0.001). Left anterior descending artery involvement (odds ratio 1.64, 95% confidence interval 1.12 to 2.39) was the strongest risk factors for dissection. Target lesion failure at 2 years occurred in 2.7% of lesions with untreated dissection compared with 4.2% of those with no dissection (log-rank p = 0.324). In conclusion, coronary dissections often complicate PCI with DCB angioplasty but do not correlate with increased risk of adverse events at midterm follow-up.
冠状动脉夹层是经皮冠状动脉介入治疗（PCI）病变准备后的一种潜在并发症。与支架不同，药物涂层球囊（DCB）无法覆盖夹层，因此需要评估其在这种情况下的安全性。本研究旨在评估基于DCB的初发冠状动脉疾病PCI术中夹层的发生率、预测因素及临床结局。2018年至2022年期间，在意大利的2个中心对连续的初发冠状动脉疾病患者进行回顾性纳入，这些患者接受了意向性DCB血管成形术的PCI治疗，无论是否植入支架。对于是否不处理夹层或进行补救性支架置入的决策，基于对心肌梗死溶栓血流、残余最小管腔直径和持续的管腔外造影剂滞留的综合血管造影评估。2年随访的主要终点是靶病变失败，这是一个包括心源性死亡、靶血管心肌梗死和临床驱动的靶病变血运重建的复合终点。在522个接受DCB治疗的病变（466例患者）中，39.1%的病例血管造影显示有夹层，其中21.1%接受了补救性支架置入，78.9%未处理。补救性支架置入的发生率从A型夹层增加到E型夹层（趋势p<0.001）。左前降支受累（比值比1.64，95%置信区间1.12至2.39）是夹层最强的危险因素。未处理夹层的病变2年靶病变失败发生率为2.7%，无夹层病变为4.2%（对数秩p=0.324）。总之，冠状动脉夹层常使DCB血管成形术的PCI复杂化，但与中期随访不良事件风险增加无关。
