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目的 探讨65岁及以上患者支架内再狭窄紫杉醇药物球囊治疗和再次置入支架的疗效及安全性. 方法 回顾性分析2015年9月至2016年9月在我院住院的60例支架内再狭窄65岁及以上患者,分别在常规球囊扩张后行紫杉醇药物球囊(DEB组,32例)扩张和再次支架置入术(DES组,28例)后治疗效果、安全性及主要观察终点管腔丢失率,次要终点为再次支架内再狭窄和主要心脏不良事件(MACE). 结果 治疗3个月后,DEB组MACE发生率为12.5％,DES组MACE发生率为28.6％(x2 =15.63,P＜0.05).治疗6个月后,DEB组靶血管丢失(0.12±0.06)mm,DES组靶血管丢失(0.21±0.04) mm,(P＜0.05).而MACE发生率分别为(18.8％和32.1％,P＜0.05).结论 65岁及以上支架内再狭窄经皮经紫杉醇药物球囊治疗支架内再狭窄,与再次置入支架治疗再狭窄相比6个月造影随访时靶血管丢失和MACE明显减少,手术安全,未见严重并发症.提示支架内再狭窄经药物球囊扩张效果明显,且可免除再次支架的置入,值得临床上进一步观察.

Objective To assess the effectiveness and safety of paclitaxel-coated balloons for in-stent restenosis in patients aged 65 years and over.Methods Sixty elderly patients(≥65 years old)with in-stent restenosis were enrolled at the Department of Cardiology,the First Affiliated Hospital of Inner Mongolian Medical University.Based on different treatment methods for in-stent restenosis,patients were divided into the drug-eluting balloon(DEB,n=32)group and the drug-eluting stent(DES,n=28)group.The primary end point was late luminal loss,determined by angiography.Secondary end points included rates of restenosis and major adverse cardiac events (MACEs).Results Quantitative coronary angiography revealed no significant differences in baseline data At 3 months after treatment,the rate of MACEs was 28.6％ in the DES group and 12.5％ in the DEB group(P＜0.05).At 6 months after treatment,angiography showed that the (x)±s of insegment late luminal loss was(0.21±0.04)mm in the DES group versus(0.12±0.06)mm in the DEB group(P ＜0.05).Furthermore,7 of 28 patients (25 ％) in the DES group had restenosis,compared with 4 of 32 patients (12.5 ％)in the DEB group(P =0.03).Conclusions Paclitaxel-coated balloons for coronary in-stent restenosis in patients aged 65 years or over can significantly reduce the incidence of restenosis and lower the rate of MACEs.The procedure is safe with no serious complications,eliminates the need for additional stent implantation,and should be further assessed in future clinical trials.