2022 年第 1 期 第 17 卷

血管内超声引导与单纯造影引导下药物涂层球囊治疗冠状动脉原位病变的效果比较

Comparison of intravascular ultrasound guided and angiography guided drug coated balloon in the treatment of coronary artery lesions in situ

作者：高霏李月平史冬梅王志坚齐静马晓腾杨丽霞周玉杰

英文作者：Gao Fei Li Yueping Shi Dongmei Wang Zhijian Qi Jing Ma Xiaoteng Yang Lixia Zhou Yujie

单位：首都医科大学附属北京安贞医院老年心血管中心，北京100029

英文单位：Geriatric Cardiovascular Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：冠心病（冠状动脉粥样硬化性心脏病）；药物涂层球囊；血管内超声

英文关键词：Coronaryatheroscleroticheartdisease；Drugcoatedballoon；Intravascularultrasound

• 摘要：

• 目的  比较血管内超声（IVUS）引导与单纯造影引导下药物涂层球囊（DCB）治疗冠状动脉原位病变的效果。方法 本研究为单中心非随机对照研究，筛选2018年1月至2021年1月于首都医科大学附属北京安贞医院行冠状动脉介入治疗并应用DCB处理冠状动脉原位病变的患者。根据DCB介入治疗时是否为IVUS引导下手术将入选患者分为IVUS引导组和单纯造影引导组。比较IVUS引导组患者DCB治疗前后IVUS检测指标。比较2组DCB治疗前后及随访时冠状动脉造影定量分析指标。结果共96例患者(单纯造影引导组68例、IVUS引导组28例)满足入排标准并完成临床及造影随访，随访时间（13±10）个月。IVUS引导组患者DCB术后即刻最小管腔面积和平均管腔面积均明显大于DCB术前，斑块负荷明显低于DCB术前(均P＜0.05)。IVUS引导组有4例（14.3%）患者在DCB术后即刻行IVUS检查时可见造影未发现的内膜夹层，夹层范围均未超过60°，围术期未出现不良事件。DCB术后即刻2组最小管腔直径均大于DCB术前(均P＜0.05)，但2组间管腔获得差异无统计学意义（P=0.32）。随访时，2组晚期管腔丢失和管腔净获得差异均无统计学意义（均P＞0.05），但IVUS引导组随访时靶病变直径狭窄率低于单纯造影引导组［（17±7）%比（27±9）%］，差异有统计学意义（P=0.03）。结论  IVUS可精准引导冠状动脉DCB治疗，与单纯造影引导相比，IVUS引导下DCB治疗冠状动脉原位病变管腔直径狭窄率更低。

• Objective   To compare the effects of drug coated balloon (DCB) guided by intravascular ultrasound (IVUS) and angiography alone on coronary artery lesions in situ. Methods  This study was a single center, non randomized controlled research. Patients who underwent coronary intervention and DCB to treat coronary artery lesions in situ in Beijing Anzhen Hospital, Capital Medical University from January 2018 to January 2021 were screened. They were divided into IVUS guidance group and simple angiography guidance group according to whether the DCB intervention was operated under the guidance of IVUS. The IVUS indexes of patients in IVUS guidance group before and after DCB were compared. The quantitative analysis indexes of coronary angiography before and after DCB and during follow-up period were compared between the two groups. Results  A total of 96 patients (68 cases in the simple angiography guidance group and 28 cases in the IVUS guidance group) met the inclusion criteria and completed the clinical and angiography follow-up. The follow-up time was (13±10)months. The minimum lumen area and average lumen area immediately after DCB in IVUS guidance group were significantly greater than those before DCB, and the plaque load was significantly lower than that before DCB (all P＜0.05). In the IVUS guidance group, 4 patients (14.3%) showed intimal dissection that was not found by angiography immediately after DCB, the range of dissection did not exceed 60°, and no adverse events occurred during the perioperative period. The minimum lumen diameter of both groups immediately after DCB was greater than that before DCB (both P＜0.05), but there was no significant difference in the lumen acquisition between the two groups (P=0.32). During follow-up, there were no significant differences in late lumen loss and net lumen gain between the two groups (both P＞0.05), but the stenosis rate of target lesion diameter in IVUS guidance group was lower than that in simple angiography guidance group［（17±7）% vs （27±9）%］（P=0.03）. Conclusion  IVUS can accurately guide the treatment of coronary artery DCB, and the stenosis rate of lumen diameter of coronary artery lesions in situ treated by DCB under the guidance of IVUS is lower than that under the guidance of angiography alone.