Murai Kota, Takagi Kensuke, Otsuka Fumiyuki, Tomishima Yoshiyuki, Iwai Takamasa, Sawada Kenichiro, Matama Hideo, Honda Satoshi, Fujino Masashi, Yoneda Shuichi, Nakao Kazuhiro, Kataoka Yu, Asaumi Yasuhide, Amemiya Kisaki, Matsumoto Manabu, Ohta-Ogo Keiko, Ikeda Yoshihiko, Ishibashi-Ueda Hatsue, Hatakeyama Kinta, Noguchi Teruo
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Department of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
Am J Cardiol. 2025 Oct 1;252:67-76. doi: 10.1016/j.amjcard.2025.05.036. Epub 2025 Jun 5.
Directional Coronary Atherectomy (DCA) is a potential treatment option for left main (LM) bifurcation lesions, as it may prevent side branch occlusion and reduce the need for complex stenting. Recent studies have suggested that combining drug-coated balloon (DCB) with DCA can lead to favorable cardiovascular outcomes. However, the comparative efficacy of DCB and current drug-eluting stents (DES) following DCA for LM bifurcation lesions remains unclear. This study aimed to compare the clinical outcomes of DCB and DES following DCA for LM bifurcation lesions. A retrospective analysis was conducted on 109 patients treated with DCA for LM bifurcation lesions from 2016 to 2024. Patients were divided into groups of DCA+DCB (n = 58) and DCA+DES (n = 51). The primary endpoint was ischemia-driven target lesion revascularization (ID-TLR), and the secondary endpoint was target lesion-related myocardial infarction (TLMI). Lesion characteristics were evaluated using quantitative coronary angiography (QCA) and intravascular ultrasound (IVUS). Kaplan-Meier analysis revealed higher ID-TLR occurrence at 5 years in the DCA+DCB group than the DCA+DES group (16.4% vs 2.3%, P = 0.027). In contrast, TLMI occurrence was similar (4.7% vs 2.3%, p = 0.667). The DCA+DCB group exhibited greater residual diameter stenosis (24.4% vs 16.3%, p <0.001) on QCA and smaller minimum lumen area (7.33 mm² vs 8.42 mm², p <0.001) and greater residual plaque area (48.9% vs 45.3%, p = 0.027) on IVUS compared to the DCA+DES group. In conclusion, the DCA+DCB strategy was associated with a higher ID-TLR incidence and a smaller luminal gain than DCA+DES. Although DCA+DCB provides a stent-less alternative, long-term monitoring is essential to address its limitations.
定向冠状动脉斑块旋切术（DCA）是治疗左主干（LM）分叉病变的一种潜在选择，因为它可能预防分支闭塞并减少复杂支架置入的需求。近期研究表明，将药物涂层球囊（DCB）与DCA联合使用可带来良好的心血管结局。然而，DCB与当前药物洗脱支架（DES）在DCA治疗LM分叉病变后的相对疗效仍不明确。本研究旨在比较DCB与DES在DCA治疗LM分叉病变后的临床结局。对2016年至2024年接受DCA治疗LM分叉病变的109例患者进行了回顾性分析。患者被分为DCA+DCB组（n = 58）和DCA+DES组（n = 51）。主要终点为缺血驱动的靶病变血运重建（ID-TLR），次要终点为靶病变相关心肌梗死（TLMI）。使用定量冠状动脉造影（QCA）和血管内超声（IVUS）评估病变特征。Kaplan-Meier分析显示，DCA+DCB组5年时的ID-TLR发生率高于DCA+DES组（16.4%对2.3%，P = 0.027）。相比之下，TLMI发生率相似（4.7%对2.3%，p = 0.667）。与DCA+DES组相比，DCA+DCB组在QCA上显示出更大的残余直径狭窄（24.4%对16.3%，p <0.001），在IVUS上显示出更小的最小管腔面积（7.33 mm²对8.42 mm²，p <0.001）和更大的残余斑块面积（48.9%对45.3%，p = 0.027）。总之，DCA+DCB策略与比DCA+DES更高 的ID-TLR发生率和更小的管腔增益相关。尽管DCA+DCB提供了一种无支架替代方案，但长期监测对于解决其局限性至关重要。
