| Background:Coronary bifurcation is a common type of coronary artery disease,accounting for 15%to 20%of it.Because of its changeable pathological features and high difficulties in operation,the overall difficulty of interventional therapy is still higher than that of non-bifurcation lesions,despite the rapid development of new techniques and new instruments in recent years.At present,the interventional treatment of true bifurcation disease can be divided into two categories:double stent operation and single stent operation.Single stenting,which means main branch stent implantation along with application of guide wire or balloon for side branch protection,due to its simple operation procedure and less perioperative complications,gradually won the recognition of evidence-based medicine.Jailed balloon techniques,as a widely used single-stenting technique,its short-term and long-term effects are still not satisfying enough.The application of cutting balloon in the pretreatment of side branch of bifurcation lesion can effectively reduce the possibility of acute occlusion of branch vessels.Drug-coating balloons instead of conventional balloons may reduce the risk of long-term restenosis in the active balloon protection technique for bifurcation lesions.Therefore,we combined cutting balloon and drug-coating balloon in true coronary bifurcation lesions.In theory,we can improve the immediate effect of coronary artery by cutting balloon pretreatment,and improve its long-term effect by applying drug-coating balloons.Objective:to evaluate the immediate and long-term effectiveness and safety of applying cutting balloon combined with drug-coating balloon in branch protection technique of coronary bifurcation lesions.Methods:60 patients in the PLA general hospital during January,2017 to June,2018 who had been diagnosed as coronary bifurcation lesions(medinal,1,1,medina0,1,1 and medina1,0,1)with main and side branch stenosis over 75%via Coronary angiography were enrolled into the study.They were divided into reseach group(28 patients)and control group(32patients)according to weather to apply drug-coating balloon(DCB)in the side breach after cutting balloon as pretreatment to the side branch.Basic clinical conditions,instant effect of the surgery,intraoperative period complications,major adverse cardiac events(MACE)[including Compound all-cause death,myocardial infarction and target lesion revascularization(TLR)]in 9 months and late lumen loss(LLL)9 months after surgery were compared between two groups.Results:There were no significant differences in basic clinical conditions and target coronary lesions[Reference vessel diameter(RVD),minimal lumen diameter(MLD)of main branch and side branch before and immediately after surgery](P>0.05).There were no intraoperative period complications in either of the two groups.There was a significant difference in MACE within 9 months between two groups[3.57%(1/28)vs25.8%(8/31),P=0.044],while TLR have no significant difference[3.57%(1/28)vs 9.88%(3/31),P>0.05].9 months after surgery,imaging examinations of some of the patients show sinificant difference in LLL[(0.04±0.07)mm vs(0.25±0.36)mm,P=0.024]and MLD[(2.50±0.48)mm vs(1.96±0.39)mm,P=0.013]of the side branch between the two groups,while LLL and MLD of the main branch showed no sinificant diffrerence.Conclusion:Applying cutting balloon combined with drug-coating balloon is effective and safe in branch protection technique of coronary bifurcation lesions. |
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