| objective: To Study the Safety and Efficacy of Drug-Coated Calloon Therapy for De Nove Coronary Lesions With Large Vessels and Long Lesions Methods: The patients were admitted to Liaoning Provincial people's Hospital from September 2016 to October 2018.The reference vessel diameter measured by coronary angiography(QCA)was between 3.0-3.5mm and the degree of stenosis was more than 70%.The length of lesion was greater than 20 mm in 90 cases.The patients were treated with drug-coated balloon(SeQuent Please ?)strategy.Coronary angiography was performed 9-12 months after operation.QCA was used to measure the degree of stenosis and the minimum internal diameter of the vessel before,after and after the angiographic examination of the patients in the catheterization room.The main cardiovascular adverse events were recorded 9 months and 12 months after operation.Statistical analysis was carried out with SPSS 25.0 software to observe the immediate success rate,late lumen loss and incidence of cardiovascular adverse events in patients with coronary artery in situ macrovascular long lesion treated with drug-coated balloon.Results: From September 2016 to October 2018,94 lesions were included in 90 patients.All of the lesions were in situ coronary artery lesions with a diameter of 3.0 to 3.5 mm.All lesions were dilated fully by ordinary preballoon,and the residual stenosis was less than 30%.The lesions were treated with drug-coated balloon.The drug-coated balloon dilated for at least 45 s,usually no more than 60s(49±3s).Among them,2 lesions appeared angiographic C-type dissection because of dilatation,and they were treated with salvage stent implantation,and 4 lesions were still more than 30% after full predilatation,and the stent strategy was used.The immediate success rate was 93.6%.There were no adverse events such as myocardial infarction and thrombus in hospital.All patients treated with drug balloon were treated with aspirin 100mg/d combined with clopidogrel 75mg/d anticoagulation for 3 months.After 3 months,these patients will only take aspirin 100mg/d for a long time.After 9 months and 12 months follow-up,85 lesions were examined by coronary angiography,and the follow-up rate was 90.4%(85 /94).Quantitative contrast analysis showed that there was significant difference between the preoperative and postoperative minimum lumen diameters(0.93±0.43 mm vs 3.27±0.56 mm p<0.05),and the immediate benefit was 2.34±0.13mm;There was no significant difference between the minimum diameter of vessel immediately after operation and that of angiography(3.27±0.56 mm vs 3.21±0.48 mm p = 0.409).The late lumen loss was 0.21 ±0.05 mm;in which positive remodeling occurred in 19 lesions and 0.07 ±0.02 mm in advanced lumen.Clinical follow-up was completed in 85 patients(94.4%)after operation,including 2 cases of target lesion revascularization,2 cases of myocardial infarction(1 case of ST segment elevation myocardial infarction,1 case of non-ST segment elevation myocardial infarction)and 4.4% of the patients with non-ST segment elevation myocardial infarction.Conclusion: 1.The application of drug balloon in the treatment of long de novo lesions of main coronary arteries has a high success rate of immediate surgery;and some patients with angiographic examination can see the phenomenon of "positive lumen positive remodeling";the incidence of MACE events is also low.2.Drug-eluting balloon treatment of long de novo lesions of main coronary arteries is safe and effective. |
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