药物涂层球囊在原发病变的临床应用价值.ppt

但并不是所有的药物球囊都有一样好的治疗效果。这项Dior DCB疗SVD的研究失败结果说明：不同DCB之间并不具有类效应，涂层的组成非常重要 * * 所以总结以下： 新普立治疗小血管病变是安全有效的，TLR在1-4%之间，DCB之间并不具有类效应。 * * 这是最新的一项关于单用DCB治疗分叉病变的多中心随机对照研究，主要治疗Medina 0,0,1 and 0,1,1 和 Medina 0,1,0分型的患者，结果显示与POBA组比较，DCB可以显著降低LLL。 Procedure手术流程 PCI technique required a two wire procedure for Medina 0,0,1 and 0,1,1 lesions, but not for Medina type 0,1,0. As first step the side branch (for Medina 0,0,1 and 0,1,1) or the distal main branch (for Medina 0,1,0) had to be dilated with an uncoated balloon with a balloon/artery ratio of 0.8-1.0. Second step was predilatation of the second branch where applicable. Randomization was performed only after successful predilatation of the distal main (Medina 0,1,0) and/or side branch (Medina 0,0,1 or Medina 0,1,1) adjudicating the patient randomly to one of the treatment options, i.e., PTCA-balloon catheter angioplasty (POBA control group) or additional Paclitaxel eluting balloon application (DEB treatment group). Results: 64 patients were successfully randomized. Minimal lumen diameter and grade of stenosis were equal in both groups. Only 5 stents were used as bail out. Angiographic follow-up was achieved in 75% of patients. No patient died. There was 1 NSTEMI in the POBA group. Restenosis rate was 26% in the POBA group vs. 6% in the DEB group (p=0.045). TLR was necessary in 3 patients of the POBA vs. 1 patient of the DEB group. The primary endpoint LLL was 0.13 mm in the DEB vs. 0.51 mm in the POBA group (p=0.013). Conclusion: In bifurcation lesions that show only class A or B dissection and recoil not beyond 30% the use of DEBs is a sound strategy 这是早期的一项关于DCB治疗分叉病变的研究，主支使用DCB+BMS，分支用DCB，9个月随访时发现分支结果很好，而主支的结果类似于一代药物支架。 * 这是另外一项在德国波茨坦医学中心的小规模注册研究，38名患者，12个月TLR为0%，再次验证了DCB的安全有效 * * 下面介绍一下DCB治疗原发病变最新的结果。这是6个月用OCT观察DCB治疗冠脉血管的结果。可以发现，即刻效果，DES（XIENCE）组最好； 而随着时间的推移，DES组出现了一定程度的LLL，而单用DCB管腔非但没有变小，而却出现了管腔增大的现象。 * 所以就引发了学术界关于单用DCB后出现晚期管腔增大的关注。这是2014年刚发表的一篇关于单用DCB 后，造影随访时管腔扩大的研究。这是患者的基线资料。 * 可以看到，DCB治疗后，造影随访时，管腔获得了不同程度的增大 * 这是随访