- 作者：Bernardo Cortese ; MD&lowast ; ; bcortese@gmail.com" class="auth_mail" title="E-mail the corresponding author ; Pedro Silva Orrego ; MD&lowast ; ; Pierfrancesco Agostoni ; MD ; PhD&dagger ; ; Dario Buccheri ; MD&lowast ; ; &Dagger ; ; Davide Piraino ; MD&lowast ; ; &Dagger ; ; Giuseppe Andolina ; MD&Dagger ; ; Romano Giuseppe Seregni ; MD&lowast ;
- 关键词：angiographic follow-up ; coronary dissection ; dissection healing ; drug-coated balloon
- 刊名：JACC: Cardiovascular Interventions
- 出版年：2015
- 出版时间：28 December 2015
- 年：2015
- 卷：8
- 期：15
- 页码：2003-2009
- 全文大小：826 K
Background
Second-generation DCB may be an alternative to stents in selected populations for the treatment of native coronary lesions. However, the use of these devices may be hampered by a certain risk of acute vessel recoil or residual coronary dissection. Moreover, stenting after DCB has shown limited efficacy. Little is known about when a non–flow-limiting dissection is left after DCB angioplasty.
Methods
This was a prospective observational study whose aim was to investigate the outcome of a consecutive series of patients with native coronary artery disease treated with second-generation DCB and residual coronary dissection at 2 Italian centers. We evaluated patient clinical conditions at 1 and 9 months, and angiographic follow up was undertaken at 6 months.
Results
Between July 2012 and July 2014, 156 patients were treated with DCB for native coronary artery disease. Fifty-two patients had a final dissection, 4 of which underwent prosthesis implantation and 48 were left untreated and underwent angiographic follow-up after 201 days (interquartile range: 161 to 250 days). The dissections were all type A to C, and none determined an impaired distal flow. Complete vessel healing at angiography was observed in 45 patients (93.8%), whereas 3 patients had persistent but uncomplicated dissections, and 3 had binary restenosis (6.2%). Late lumen loss was 0.14 mm (−0.14 to 0.42). Major adverse cardiovascular events occurred in 11 patients in the entire cohort and in 4 of the dissection cohort (7.2% vs. 8.1%; p = 0.48). We observed 8 and 3 target lesion revascularizations, respectively (5.3% vs. 6.2%; p = 0.37).
Conclusions
In this cohort of consecutive patients treated with new-generation DCB and left with a final dissection, this strategy of revascularization seemed associated with the sealing of most of dissections and without significant neointimal hyperplasia.