Clinical value of drug-coated balloon angioplasty for de novo lesions in patients with coronary artery disease
Clinical value of drug-coated balloon angioplasty for de novo lesions in patients with coronary artery disease
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DOI：
10.1016/j.ijcard.2016.07.156
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发表时间：
2016-11-01
影响因子：
3.5
通讯作者：
Taguchi, Isao
中科院分区：
文献类型：
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作者：
Nishiyama, Naoki;Komatsu, Takaaki;Taguchi, Isao
背景：尽管药物洗脱支架（DES）的再狭窄率较低，但仍然存在一些问题，包括支架血栓、支架断裂和新生动脉粥样硬化。 “无支架”（仅球囊）经皮冠状动脉介入治疗 (PCI) 仍在使用，多项临床试验也支持 DCB 的功效。本研究的目的是探讨药物涂层球囊 (DCB) 在治疗新发冠状动脉疾病中的疗效。方法：我们连续招募了 60 名在 2014 年 5 月至 2015 年 6 月期间接受选择性 PCI 的患者。他们被随机分配到“无支架”组 (n = 30) 和“支架”组 (n = 30)。 27 名患者单独接受 DCB 治疗，33 名患者接受 DES 治疗，然后在 8 个月后评估靶病灶血运重建（TLR）率并通过定量冠状动脉造影（QCA）进行评估。结果：两组 TLR 率相似（DCB；0.0%，DES；6.1%，P = 0.169）。在 QCA 分析中，PCI 后 DCB 组的最小管腔直径 (MLD) 和急性增益显着小于 DES 组（分别为 2.36 +/- 0.46 vs 2.64 +/- 0.37，P = 0.011，以及 1.63 +/- 0.41 vs 2.08 +/- 0.37，P < 0.0001）。然而，PCI 后八个月，两组之间的 MLD 或晚期管腔丢失没有显着差异。结论：使用 DCB 的“无支架”PCI 即使在 DES 时代也可能有用。 “无支架”PCI 后，与 DES 植入后相比，可以更安全地减少或停用抗血小板药物。 (C) 2016 Elsevier Ireland Ltd. 保留所有权利。
Background: Despite the low restenosis rates of drug-eluting stents (DES), several problems remain, including stent thrombosis, stent fracture, and neo-atherosclerosis. 'Stent-less' (balloon alone) percutaneous coronary intervention (PCI) is still being used, and several clinical trials have supported the efficacy of DCB. The aim of this study was to investigate the efficacy of a drug-coated balloon (DCB) in the treatment of de novo coronary artery disease.Methods: We enrolled 60 consecutive patients who had been given elective PCI between May 2014 and June 2015. They were randomly assigned to a 'stent-less' group (n = 30) and a 'stent' group (n = 30). Twenty-seven patients were treated with DCB alone and 33 with DES, and then evaluated for target lesion revascularization (TLR) rate and by quantitative coronary angiography (QCA) eight months later.Results: TLR rates were similar in the two groups (DCB; 0.0%, DES; 6.1%, P = 0.169). In the QCA analysis, minimal lumen diameter (MLD) and acute gain were significantly smaller in the DCB group than in the DES group immediately after PCI (2.36 +/- 0.46 vs 2.64 +/- 0.37, P = 0.011, and 1.63 +/- 0.41 vs 2.08 +/- 0.37, P < 0.0001, respectively). Eight months after PCI, however, there was no significant difference in MLD or late lumen loss between the two groups.Conclusions: A 'stent-less' PCI using DCB could be useful even in the DES era. After 'stent-less' PCI, antiplatelet agents might be reduced or discontinued more safely than after DES implantation. (C) 2016 Elsevier Ireland Ltd. All rights reserved.