2020 年第 8 期 第 15 卷

联合应用准分子激光冠状动脉斑块消融术和药物涂层球囊治疗冠状动脉支架内再狭窄的观察性研究

The combined use of drug eluting balloon and excimer laser during stent treatment of coronary artery restenosis

作者：杨丽霞周玉杰王志坚史冬梅柴萌梁静张琳琳

英文作者：Yang Lixia Zhou Yujie Wang Zhijian Shi Dongmei Chai Meng Liang Jing Zhang Linlin

单位：首都医科大学附属北京安贞医院心内十二病房北京市心肺血管疾病研究所100029

英文单位：The 12th Ward Department of Cardiology Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：冠状动脉支架再狭窄；准分子激光；药物球囊

英文关键词：In-stentrestenosisofcoronaryartery；Excimerlasercoronaryangioplasty；Drugelutingballoon

• 摘要：

• 目的 对比联合应用准分子激光冠状动脉斑块消融术（ELCA）和药物涂层球囊（DCB）与单独应用DCB治疗冠状动脉支架内再狭窄（ISR）的效果。方法 选取2017年1月至2019年12月在首都医科大学附属北京安贞医院应用DCB处理冠状动脉ISR并接受光学相干断层成像检查的患者32例。根据是否接受ELCA将患者分为ELCA组（应用ELCA联合DCB，12例，15处病变）和对照组（单独应用DCB，20例，24处病变）。比较2组光学相干断层成像测量治疗前后的即刻管腔获得、支架扩张面积及术中不良事件发生情况。结果 ELCA组即刻管腔获得明显高于对照组［（3.4±0.9）mm2比（1.9±0.5）mm2］（P=0.03），2组支架扩张面积比较，差异无统计学意义（P=0.91）。ELCA组和对照组各有1例患者DCB应用后出现A型或B型夹层，未予进一步处理。对照组1例患者第1个DCB通过困难，经再次处理后第2个DCB通过。ELCA组1例、对照组2例出现无复流,对症治疗后好转。结论 联合应用ELCA和DCB治疗ISR较单独应用DCB治疗ISR能得到更大的即刻管腔获得，且不增加并发症发生率。

• Objective To observe the effects of combined application of excimer laser coronary plaque ablation (ELCA) and drug-coated balloon (DCB) with DCB alonein patient with ISR. Methods Twelve consecutive patients treated with ELCA & DCB（ELCA group）and 20 consecutive patients treated with DCB standard therapy（control group） from January 2017 to December 2019 in Beijing Anzhen Hospital were included; angiographic and OCT outcomes were evaluated. Lumen measurement with OCT was performed before and after procedure. The primary endpoint was OCT derived acute lumen gain. Results The lumen obtained in the ELCA group was significantly higher than that in the control group ［(3.4 ± 0.9) mm2 vs (1.9 ± 0.5) mm2， P=0.03］; there was 1 dissection (Type A or B) in each group; 1 patient had no-reflow in ELCA group; 2 patients had no-reflow in control group. Conclusion The combination use of ELCA with DCB in patients with ISR has more acute lumen gain compared with the use of DCB; there was no significant difference of procedural complication between two groups.