| Background and purpose:In the 21st century,cardiovascular disease has become one of the diseases with the highest lethality and disability in the population.As a common disease of the cardiovascular system,the incidence of coronary artery disease has also increased year by year,seriously threatening human health.Although the benefits of stent implantation are obvious today when interventional techniques are popularized,the current status of coronary artery disease treatment has been alleviated to a certain extent,but the limitations faced by its clinical application have also become more apparent.In-stent restenosis(ISR),branch disease and small vessel disease treatment,in-stent thrombosis,and bleeding caused by the antiplatelet drugs have limit the application of stent technology.The emergence of these problems has also promoted the development of drug-coated balloon(DCB)technology.Compared with drug-coated stents,DCB avoids the related problems caused by stent implants and breaks through the limitations of the clinical application of stent technology.However,there is still insufficient clinical evidence for the treatment of DCB in situ coronary artery lesions,and further research is needed.Although DCB is currently recommended as an IA treatment for ISR,the incidence of recurrence and stenosis of target lesions after DCB is still as high as 20%.Studies have found that the extension of DCB expansion time can reduce the incidence of restenosis of target lesions.The release of balloon drugs is time-dependent,and the extension of the inflation time increases the concentration of drugs in the blood vessel wall,which in turn improves the rate of target lesion restenosis.However,the tolerance of myocardial ischemia limits the time of balloon inflation.How to enhance the tolerance of myocardial ischemia caused by DCB inflation and whether DCB treatment-related operations will cause myocardial damage is worth discussing.In recent years,remote ischemic preconditioning(RIPC)has been shown to improve coronary microcirculation,reduce myocardial ischemia-reperfusion injury,and improve long-term prognosis.In view of this,this study aimed to observe the effect of RIPC on DCB tolerance time and the effect of RIPC combined with DCB in the treatment of coronary artery in situ lesions.Methods and Materials:from May 2018 to May 2019,96 patients who were admitted to the second ward of coronary artery disease in the Department of Cardiology,Huazhong Fuwai Cardiovascular Hospital due to Unstable angina,and diagnosed as coronary artery disease with coronary artery in-situ de novo lesion by coronary angiography were selected.Randomly divided into remote ischemic preconditioning group(RIPC group)and sham RIPC group.Immediately after coronary angiography,patients in the RIPC group were treated with RIPC(Place cuff on left upper limb and pressurize to 200mmhg,inflate for 5min+deflate for 5min;×3 cycles),and patients in the control group were also placed with cuffs but not inflated.The two groups of patients were treated with a drug-coated balloon(SeQuentPlease(?))strategy.The patient's drug balloon inflation time was determined based on the patient's intraoperative clinical manifestations and whether there was ischemic change in ECG monitoring.Observe and record the DCB dilation time of the two groups of patients,and the peripheral blood cardiac troponin T level at 24 hours after surgery,and be admitted to the hospital 6 months after surgery to undergo coronary angiography again.Quantitative coronary angiography data such as immediate lumen acquisition and late lumen loss during pre-operative,post-operative,and 6-month review of angiography were collected.Statistical analysis was performed using SPSS 22.0 statistical software.Results:A total of 96 patients with coronary artery disease were included in this study,with a total of 106 lesions.All the lesions were coronary in-situ de novo lesions.The remote ischemic preconditioning group included 48 patients(52 lesions)and the control group 48 patients(54 Lesions).All lesions were treated with drug-coated balloons,and the success rate was 100%.Age,gender,smoking status,hypertension,hyperlipidemia,diabetes,BMI,cardiac function classification(NYHA),CCS angina pectoris classification,preoperative Ctnt,left ventricular ejection fraction,operation duration,Diseased vessels,diseased length,and postoperative medication were not statistically different(P>0.05).Intraoperative drug balloon inflation time of the two groups of patients,RIPC group:121±31S,significantly longer than sham RIPC group:73±17S,the difference was statistically significant(P<0.001).The cTnT level in peripheral blood of the two groups of patients at 24 hours after operation was 0.138±0.055ng/ml in the RIPC group,which was significantly lower than that in the RIPC group:0.189±0.069ng/ml,the difference was statistically significant(P<0.001).The results of quantitative analysis of coronary angiography were reviewed immediately and 6 months after operation in the two groups:lumen obtained immediately after operation,RIPC group:1.88±0.34mm,sham RIPC group:1.81±0.31mm,the difference was not statistically significant(P>0.05);late lumen loss 6 months after surgery,RIPC group:-0.31±0.22mm,significantly smaller than sham RIPC group:-0.17±027mm,the difference was statistically significant(P<0.05).Conclusion:The results of this experimental study suggest that remote ischemic preconditioning can extend the tolerance time of drug balloon inflation in patients with coronary artery disease.Remote ischemic preconditioning adjuvant drug balloon therapy can alleviate the increase of postoperative cTnT levels caused by drug balloon therapy.Compared with simple drug balloon therapy,adjuvant drug balloon therapy with remote ischemic preconditioning does not improve the lumen acquisition immediately after surgery,but it can reduce the loss of lumen in patients at 6 months later. |
PDF Full Text Request