| Background and Objectives: Percutaneous coronary intervetion (PCI) has become a well-established technique for myocardial revascularization of patients with coronary artery disease. Despite a primary success rate greater than 95 %, acute and subacute thrombosis is still associated with a high risk of death and nonfatal myocardial infarction, and the long-term benefit continues to be compromised by the recurrence of stenitic lesions. Restenosis affects 30 % to 50 % of treated patients within 3 to 6 months. Recent studies have demonstrated that the injury of endothelium is the startup factor of restenosis. Balloon angioplasty typically injures the vessel wall by inducing irregular intimal tears, splits and stretches. The dissection of endothelium exposes collagen and lipid to blood, which can induces changes in expression of coagulation and fibrinolysisfactors, as well as activation of platelets. Activation of platelets results in early thrombin generation, leading to release of various vasoactive substances and growth factors. In addition, thrombin itself can act as a mitogen for vascular smooth muscle cells. So intracoronary thrombus formation is believed to play an important role in the pathogenesis of abrupt vessel occlusion after coronary angioplasty and possibly late restenosis. Cutting Balloon is a new balloon angioplasty device with 3 or 4 microtome sharp metal blades mounted longitudinally on the surface of the balloon. During dilation, the device produces 3 or 4 endovascular surgical incisions, and a controlled geometric model is formed. As a result, the longitudinal incisions of plaque and vessel wall reduce true dissection rates as well as nominal vessel area decrease. Thus, cutting balloon angioplasty may limit the degree of traumatic vessel wall injury, typically encountered in conventional balloon angioplasty. Most clinical studies have demonstrated that cutting balloon angioplasty can lead to decreased restenosis rate. However, the mechanism by which the trauma is beneficial are still not to be clinically established. The purpose of this study was to assess the coagulation, fibrinolysis and platelet activation in coronary sinus blood induced by cutting balloon angioplasty.Methods: We selected 51 patients for either cutting balloon angioplasty (group CBA, 22 patients)' or plain old balloon angioplasty (group POBA, 29 patients). All patients have at least one significant angiographic stenosis (>70 %, in diameter), and occlusive lesions were excluded. Stents were installed after balloon angioplasty. The expression of thrombin activition, D-Dimer levels, tissue-type plasminogen activator (t-PA) and plasminogen activator inhibitor 1 (PAI-1) levels were detected at different timepoints before and after PCIprocedure. All venous blood samples were obtained from the coronary sinus. Results:1. The thrombin activition in group CBA decreased significantly at 6 hr after PCI compare with the preprocedures' (P<0.05). In group POBA, there was a slight decrease at 6 hr, but it didn't have significant difference (P>0.05). And group POBA's thrombin activition was markedly higher than group CBA at 6hr(P<0.05).2. Two groups' D-Dimer levels dramatically increased at 6 hr after the procedure (P<0.01). But there was no prominent difference between the two groups (P>0.05).3. In group POBA, the t-PA level increased immediately after balloon angioplasty (P<0.05) and the trend continued at 6 hr (P<0.01). While in group CBA, although there was a significantly increase at 6 hr (P<0.05), its level was lower than that in group POBA (P<0.05). PAI-1 levels gently increased at postprocedure in two groups, but there was no statistic significance (P>0.05).4. Soluble P-selectin levels decreased markedly at 30 min after the procedure in group POBA (P<0.01), and was lower than that in group CBA (P <0.05). Soluble P-selectin levels in group CBA didn't decrease significantly at postprocedure 30 min (P=0.064).Conclusions:1. The lesion induced by CBA associated with stents implantation or POBA...
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