Calcium Burden Assessment and Impact on Drug-Eluting Balloons in Peripheral Arterial Disease
Calcium Burden Assessment and Impact on Drug-Eluting Balloons in Peripheral Arterial Disease
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DOI：
10.1007/s00270-014-0904-3
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发表时间：
2014-08-01
影响因子：
2.9
通讯作者：
Salvatori, F. M.
中科院分区：
文献类型：
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作者：
Fanelli, F.;Cannavale, A.;Salvatori, F. M.
本研究旨在评估在狭窄梗阻性SFA病变血运重建过程中钙对DEB疗效的影响。60例新发股浅动脉病变患者采用药物洗脱球囊（DEB）血管内治疗。根据血管参考直径（1:1）选择DEB。对于残余狭窄50%或限流夹层，采用常规球囊或临时支架进行扩张。根据ct血管造影轴向图像上钙的周向分布（0 ~ 360A度）和数字减影血管造影评价钙的长度（<或≤3cm）将患者分为8组。1年随访时评估踝臂指数（ABI）、晚期管腔损失（LLL）、靶病变血运重建术（TLR）、原发性（PP）和继发性（SP）开放、主要不良事件（MAE）和卢塞福转移（Rutherford shift），并与钙的量相关。所有病例血运重建均成功。血流受限夹层5例（8.3%）出现高周钙度，3例扩张后解决，2例临时支架置入解决。钙浓度高的患者DEB效应较低（bbb270a度vs < 90A度）：ABI为0.71 +/- A 0.07 vs 0.92 +/- A 0.07；LLL 0.75 +/- A 0.21 vs 0.45 +/- A 0.1；PP 50% vs 100%；标普50对100%；TLR 25 vs 0%；MAE是25%比0%。钙是最佳药物吸收的屏障。周向分布似乎是影响最大的因素，在360A钙存在时影响最差。
This study was designed to assess the effect of calcium on the efficacy of DEB during revascularization of steno-obstructive SFA lesions.Sixty patients with de novo lesions of the superficial femoral artery underwent endovascular treatment with drug eluting balloons (DEB). DEB was selected according to vessel reference diameter (1:1). In case of residual stenosis > 50 % or flow-limiting dissection, postdilatation with conventional balloon or provisional stenting was done. Patients were classified into eight groups according to circumferential distribution of calcium on CT-angiography axial images (from 0A degrees to 360A degrees) and to its length (length < or > 3 cm) evaluated with digital-subtraction-angiography. Ankle-brachial index (ABI), late lumen loss (LLL), target lesion revascularization (TLR), primary (PP) and secondary (SP) patency, major adverse events (MAE), and Rutherford shift were evaluated at 1-year follow-up and correlated with the amount of calcium.Revascularization was successful in all cases. Flow-limiting dissection occurred in five cases (8.3 %) with a higher circumferential degree of calcium and solved in three cases with postdilatation and in the other two with provisional stenting. DEB effect was lower in patients with higher degree of calcium (> 270A degrees vs. < 90A degrees): ABI 0.71 +/- A 0.07 versus 0.92 +/- A 0.07; LLL 0.75 +/- A 0.21 versus 0.45 +/- A 0.1; PP 50 versus 100 %; SP 50 versus 100 %; TLR 25 versus 0 %; MAE 25 versus 0 %.Calcium represents a barrier to optimal drug absorption. Circumferential distribution seems to be the most influencing factor with the worst effect noticed in 360A degrees calcium presence.