| BackgroundCoronary bifurcation lesions refer to coronary artery stenosis occurring adjacent to,or at an important side branch that was indestructible.Due to the complexity of its anatomical features and the possible dynamic changes in the anatomical structure such as plaque shift during interventional therapy,it is regarded as one of the challenging lesions.Despite the birth of the drug-eluting stent(DES)improves the prognosis of coronary artery bifurcation lesions significantly,the incidence of late in-stent restenosis(ISR)and stent thrombosis is still unsatisfactory.Recently,the best method for coronary artery bifurcation has been a hot topic.Nowadays provisional stenting technique strategy is considered the first choice for most of the bifurcations.Studies have shown that this procedure had superior results in reducing the incidence of major adverse cardiovascular events.However,the incidence of risks such as occlusion and aggravation of stenosis in the side branch(SB)during operations was still unsatisfactory.The use of DES in combination with drug-coated balloon(DCB)to treat the main branch(MB)and SB vessels respectively under the principle of provisional stenting technique offer an another alternative.The DCB does not have polymer matrix compared with the DES.It can transfer the anti-proliferative drug to the arterial wall rapidly and evenly and comes to effect quickly for vessel endothelialization.However,whether the combination can lead to excessive neointimal proliferation is still controversial.There is an upward trend of the coronary bifurcation lesions in elderly people who are with high risk of coronary intervention complication as aging.Currently there were a few studies on coronary bifurcation lesions.ObjectiveWe retrospective analysed the main medical history,intraoperative data,the majore adverse cardiovascular events and the progress of stenosis in side branch in elderly patients with non-left main coronary artery bifurcation lesions and with the treatment of DCB or normal balloon at SB after the main vessel stenting with DES,under the principle of provisional stenting technique,in order to explore the feasibility result of supplementary treatment of paclitaxel coated balloon at SB after the main vessel stenting in patients with non-left main coronary artery bifurcation lesions in the elderly,according to the principle of provisional stenting technique.Methods101 elderly patients(≥60 years old)were selected into the study from Huaihe hospital of henan university between March 2016 to March 2018.The coronary heart disease were demonstrated by coronary angiography revealing coronary bifurcation lesions.After the stent implantation in the MB with DES,the side branch did not consider stent implantation,only dilated with DCB or normal balloon dilation according to the Inclusion and Exclusion Criteria.According to the treatment method of the patient’s side branch vessels,We divided the 101 patients into two groups: the normal balloon treatment group(the side branch was dilated by normal balloon);the drug-coated balloon treatment group(the side branch was dilated by drug-coated balloon).The collection of the relevant data in enrolled patients was performed,including general baseline data,surgical related data and following-up data.The SPSS 19.0 was used as a statistical software,using a bilateral test and considering statistically significant at P<0.05.Results1.The number of patients selected were 101,including 55 and 46 patients in the normal balloon group and the drug-coated balloon group,respectively.The two groups were treated with quantitative coronary angiography(QCA)to analyze the most severe minimal luminal diameter(MLD)of the side branch vessel stenosis before and after treatment.The MLD of the side branch increased from(1.22±0.12)mm to(1.61±0.10)mm in the normal balloon group,and(1.24±0.11)mm to(1.69±0.79)mm in the drug-coated balloon group.The results showed no distinction in MLD before operative between the two groups(P>0.05),not like the difference in postoperative(P<0.05).2.Two patients(3.6%)had angina in the normal balloon group and one patient(2.2%)in the drug-coated balloon group during hospitalization,presenting with CCS-I,which did not display any statistical distinction(P>0.05).No myocardial infarction,death as well as target vessel revascularization(TVR)occured in both groups.3.No target vessel myocardial infarction appeared in the follow-up of 0-3 months,3-6 months and 6-12 months.The proportion of angina occurred in the two groups during the follow-up period from discharge to 3-month was statistically significant(P<0.05).There was no difference in statistical about the frequency of angina from 3-6 months and 6-12 months(P>0.05).During the follow-up period from 3-6 months,1 myocardial infarction occurred in the normal balloon group.In the time of 6-12 months,2 target vessel revascularization occurred in the normal balloon group,and 1 non-cardiac death in the drug-coated balloon group.No statistical significance was showed in the two groups(P>0.05).4.Coronary angiography was performed in 15(27.3%)patients in the normal balloon group driven by symptom.Three people were demonstrated with the the progress of the stenosis in side branch vascular,where two with TVR and the other had no need for further intervention;A total of 9(19.6%)of the drug-coated balloon group were driven by symptom to re-examination of the angiography in the hospital.Only one was demonstrated with the progress of the stenosis in side branch vascular and no one need to receive the target vessel revascularization.Conclusion1.In elderly patients with non-left main coronary artery bifurcation lesions,supplementary treatment of paclitaxel DCB at SB after the main vessel stenting with DES,at the principle of provisional stenting technique,is a feasible method.It can effectively improve MLD.2.The application of DCB in the management of non-left main coronary artery bifurcation lesions in the elderly showed no superiority in safety compared with the normal balloon. |
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