程治源,马文锐,潘子磊,能昌盛,常尚,梁力,张瑶俊,李谦

• 1:徐州市肿瘤医院徐州市第三人民医院心血管内科

摘要(Abstract)：

目的 探讨药物涂层球囊（DCB）处理冠状动脉原位原发病变后未经治疗的遗留夹层临床预后。方法 回顾性分析2017年9月至2023年4月于徐州市肿瘤医院、徐州新健康老年病医院、沛县国泰医院在造影指导下经DCB治疗冠状动脉原位原发病变（2.5～4.0 mm）患者的临床资料及影像资料。根据造影观察是否出现冠状动脉夹层，分为夹层组和无夹层组，观察主要终点是随访12个月主要不良心血管事件（MACE）。结果 3家研究中心共纳入381例患者，夹层组30例（30处病变），无夹层组351例（367处病变）。两组患者年龄、性别、高血压病、高脂血症、糖尿病、吸烟、既往心肌梗死、既往经皮冠状动脉介入治疗、冠状动脉旁路移植术史等基线临床特征比较，差异均无统计学意义（均P>0.05）。两组患者参考血管直径（P=0.049）和DCB压力比较（P=0.032），差异均有统计学意义；在冠状动脉造影病变特征方面比较，差异均无统计学意义（均P>0.05）。随访12个月，DCB治疗冠状动脉原位原发病变后夹层组与无夹层组MACE发生率比较，差异无统计学意义（P>0.05）。结论 DCB治疗冠状动脉原位原发病变后未经治疗的遗留夹层不会导致临床MACE的增加。

关键词(KeyWords)： 药物涂层球囊;冠状动脉夹层;原位原发病变

Abstract:

Keywords:

基金项目(Foundation): 徐州市重点研发计划项目(KC22100)

作者(Author): 程治源,马文锐,潘子磊,能昌盛,常尚,梁力,张瑶俊,李谦

参考文献(References)：

• [1] Jeger RV,Eccleshall S,Wan Ahmad WA,et al. Drugcoated balloons for coronary artery disease:third report of the international DCB consensus group[J]. JACC Cardiovasc Interv,2020,13(12):1391-1402. DOI:10.1016/j.jcin.2020.02.043.
• [2] Leimgruber PP,Roubin GS,Hollman J,et al. Restenosis after successful coronary angioplasty in patients with single-vessel disease[J]. Circulation,1986,73(4):710-717. DOI:10.1161/01.cir.73.4.710.
• [3] Ghetti G,Bendandi F,Donati F,et al. Predictors of bail-out stenting in patients with small vessel disease treated with drug-coated balloon percutaneous coronary intervention[J]. Catheter Cardiovasc Interv,2023,102(1):18-24. DOI:10.1002/ccd.30688.
• [4] Her AY,Ahmad WAW,Bang LH,et al. Drug-coated balloonsbased intervention for coronary artery disease:the second report of Asia-Pacific Consensus Group[J]. JACC Asia,2025,5(6):701-717. DOI:10.1016/j.jacasi.2025.02.017.
• [5]《药物涂层球囊临床应用中国专家共识（第二版）》专家组.药物涂层球囊临床应用中国专家共识（第二版）[J].中国介入心脏病学杂志，2023,31(6):413-426. DOI:10.3969/j. issn. 1004-8812. 2023. 06. 003.
• [6] Hu FW,Chang S,Li Q,et al. Long-term clinical outcomes after percutaneous coronary intervention with drug-coated balloon-only strategy in de novo lesions of large coronary arteries[J]. Front Cardiovasc Med,2022,9:882303. DOI:10.3389/fcvm.2022.882303.
• [7] Her AY,Shin ES,Bang LH,et al. Drug-coated balloon treatment in coronary artery disease:recommendations from an Asia-Pacific Consensus Group[J]. Cardiol J,2021,28(1):136-149. DOI:10.5603/CJ.a2019.0093.
• [8] Cowley MJ,Dorros G,Kelsey SF,et al. Acute coronary events associated with percutaneous transluminal coronary angioplasty[J]. Am J Cardiol,1984,53(12):12C-16C. DOI:10.1016/0002-9149(84)90738-0.
• [9] Schroeder S,Baumbach A,Mahrholdt H,et al. The impact of untreated coronary dissections on acute and long-term outcome after intravascular ultrasound guided PTCA[J]. Eur Heart J,2000,21(2):137-145. DOI:10.1053/euhj.1999.1754.
• [10] Cappelletti A,Margonato A,Rosano G,et al. Short-and longterm evolution of unstented nonocclusive coronary dissection after coronary angioplasty[J]. J Am Coll Cardiol,1999,34(5):1484-1488. DOI:10.1016/s0735-1097(99)00395-2.
• [11] Cortese B,Silva Orrego P,Agostoni P,et al. Eff ect of drugcoated balloons in native coronary artery disease left with a dissection[J]. JACC Cardiovasc Interv,2015,8(15):2003-2009.DOI:10.1016/j.jcin.2015.08.029.
• [12] Belkacemi A,Agostoni P,Nathoe HM,et al. First results of the DEB-AMI(drug eluting balloon in acute ST-segment elevation myocardial infarction)trial:a multicenter randomized comparison of drug-eluting balloon plus bare-metal stent versus bare-metal stent versus drug-eluting stent in primary percutaneous coronary intervention with 6-month angiographic,intravascular,functional,and clinical outcomes[J]. J Am Coll Cardiol,2012,59(25):2327-2337. DOI:10.1016/j.jacc.2012.02.027.
• [13] Jeger RV,Eccleshall S,Wan Ahmad WA,et al. Drug-coated balloons for coronary artery disease:third report of the International DCB Consensus Group[J]. JACC Cardiovasc Interv,2020,13(12):1391-1402. DOI:10.1016/j.jcin.2020.02.043.
• [14] Paulo M,Sandoval J,Lennie V,et al. Combined use of OCT and IVUS in spontaneous coronary artery dissection[J]. JACC Cardiovasc Imaging,2013,6(7):830-832. DOI:10.1016/j.jcmg.2013.02.010.
• [15] Tweet MS,Gulati R,Williamson EE,et al. Multimodality imaging for spontaneous coronary artery dissection in women[J]. JACC Cardiovasc Imaging,2016,9(4):436-450.DOI:10.1016/j.jcmg.2016.01.009.
• [16] Yamamoto T,Sawada T,Uzu K,et al. Possible mechanism of late lumen enlargement after treatment for de novo coronary lesions with drug-coated balloon[J]. Int J Cardiol,2020,321:30-37. DOI:10.1016/j.ijcard.2020.07.028.
• [17] Funatsu A,Kobayashi T,Mizobuchi M,et al. Clinical and angiographic outcomes of coronary dissection after paclitaxelcoated balloon angioplasty for small vessel coronary artery disease[J]. Cardiovasc Interv Ther,2019,34(4):317-324.DOI:10.1007/s12928-019-00571-3.
• [18] Liu Y,Zhang YJ,Deng LX,et al. 12-month clinical results of drug-coated balloons for de novo coronary lesion in vessels exceeding 3.0 mm[J]. Int J Cardiovasc Imaging,2019,35(4):579-586. DOI:10.1007/s10554-018-1505-z.
• [19] Hui L,Shin ES,Jun EJ,et al. Impact of dissection after drug-coated balloon treatment of de novo coronary lesions:angiographic and clinical outcomes[J]. Yonsei Med J,2020,61(12):1004-1012. DOI:10.3349/ymj.2020.61.12.1004.
• [20] Yu X,Ji F,Xu F,et al. Treatment of large de novo coronary lesions with paclitaxel-coated balloon only:results from a Chinese institute[J]. Clin Res Cardiol,2019,108(3):234-243. DOI:10.1007/s00392-018-1346-8.
• [21] Hermans WR,Rensing BJ,Foley DP,et al. Therapeutic dissection after successful coronary balloon angioplasty:no infl uence on restenosis or on clinical outcome in 693 patients. The MERCATOR Study Group(Multicenter European Research Trial with Cilazapril after Angioplasty to prevent Transluminal Coronary Obstruction and Restenosis)[J]. J Am Coll Cardiol,1992,20(4):767-780. DOI:10.1016/0735-1097(92)90171-i.
• [22] Bourassa MG,Lespérance J,Eastwood C,et al. Clinical,physiologic,anatomic and procedural factors predictive of restenosis after percutaneous transluminal coronary angioplasty[J]. J Am Coll Cardiol,1991,18(2):368-376. DOI:10.1016/0735-1097(91)90588-z.
• [23] Lu W,Zhu Y,Han Z,et al. Short-term outcomes from drug-coated balloon for coronary de novo lesions in large vessels[J]. J Cardiol,2019,73(2):151-155. DOI:10.1016/j.jjcc.2018.07.008.
• [24] Fahrni G,Scheller B,Coslovsky M,et al. Drug-coated balloon versus drug-eluting stent in small coronary artery lesions:angiographic analysis from the BASKET-SMALL 2 trial[J].Clin Res Cardiol, 2020,109(9):1114-1124. DOI:10.1007/s00392-020-01603-2.
• [25] W?hrle J,Zadura M,M?bius-Winkler S,et al. SeQuentPlease World Wide Registry:clinical results of SeQuent please paclitaxel-coated balloon angioplasty in a large-scale,prospective registry study[J]. J Am Coll Cardiol,2012,60(18):1733-1738. DOI:10.1016/j.jacc.2012.07.040.
• [26] Jensen LO,Thayssen P,Christiansen EH,et al. Safety and efficacy of everolimus-versus sirolimus-eluting stents:5-year results from SORT OUT IV[J]. J Am Coll Cardiol,2016,67(7):751-762. DOI:10.1016/j.jacc.2015.11.051.
• [27]曾川锐，余家凤，刘映峰，等.药物涂层球囊应用于冠状动脉原发病变的研究进展[J].中国介入心脏病学杂志，2020,28(1):39-43. DOI:10.3969/j.issn.1004-8812.2020.01.009.