本文選題：藥物涂層球囊 + 支架內(nèi)再狹窄　； 參考：《介入放射學(xué)雜志》2017年04期

【摘要】：目的探討以單純紫杉醇藥物涂層球囊(DCB)擴張冠狀動脈介入治療術(shù)后支架內(nèi)再狹窄(ISR)病變段,觀察遠期靶血管管腔面積,從而證實DCB在ISR病變中的作用。方法選取4例符合DCB適應(yīng)證ISR患者,按照標準流程在充分預(yù)擴張基礎(chǔ)上予以紫杉醇DCB擴張病變段,不植入支架。術(shù)后即刻及術(shù)后9個月采用冠狀動脈造影和血管內(nèi)超聲檢測患者最小管腔橫截面積(MLA)、支架橫截面積(SA)和血管內(nèi)膜增生狀況。結(jié)果 4例患者單純紫杉醇DCB治療后即刻造影顯示靶血管擴張段無夾層,無明顯殘余狹窄。術(shù)后9個月造影顯示所有患者靶血管擴張段管腔通暢,病變段未見明顯再狹窄,TIMI血流3級;血管內(nèi)超聲檢測顯示MLA均較術(shù)后即刻顯著增加,SA呈增加趨勢,內(nèi)膜增生呈抑制趨勢。結(jié)論單純DCB擴張ISR病變可增加遠期管腔面積,避免二次支架植入,降低再次ISR風(fēng)險,并通過局部釋放紫杉醇作用于管壁,抑制內(nèi)膜過度增生。
[Abstract]:Objective to investigate the angioplasty of restenosis after percutaneous coronary intervention with paclitaxel coated balloon, and to observe the long term target vascular lumen area, so as to confirm the role of DCB in the pathogenesis of ISR. Methods four patients with ISR according to DCB indication were selected and treated with paclitaxel DCB on the basis of full predilation according to the standard procedure without stent implantation. Coronary angiography and intravascular ultrasound were used to detect the minimum lumen cross sectional area (MLAA), stent cross sectional area (SAA) and intimal hyperplasia in patients immediately after operation and 9 months after operation. Results immediately after paclitaxel DCB alone, 4 patients showed no dissection and no residual stenosis in the target vasodilation segment. 9 months after operation, the angiographic findings showed that the lumen of target vasodilation segment was patency, no restenosis was found in the lesion segment and TIMI blood flow was grade 3. Intravascular ultrasound examination showed that MLA increased significantly compared with that immediately after operation, and intimal hyperplasia showed an increasing trend, while intimal hyperplasia showed a tendency of inhibition. Conclusion simple DCB dilatation of ISR can increase long-term lumen area, avoid secondary stent implantation, reduce the risk of re-ISR, and inhibit intimal hypertrophy by local release of paclitaxel.
【作者單位】： 上海交通大學(xué)附屬第六人民醫(yī)院心內(nèi)科;
【分類號】：R543.3

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