Clinical Application Of Drug Coated Balloon And Drug Eluting Stent In Treatment Of In Stent Restenosis

Background:Percutaneous coronary intervention(PCI) has become one of the most important treatments of coronary artery disease, and with the use of drug-eluting stent(DES) clinical outcomes have been drastically improved. But we still can’t avoid in stent restenosis(ISR), which is also the hot area of research for several years.Purpose: In this study we compared the treatment with drug coated balloon(DCB) and DES in treatment of ISR, and also evaluated the risk factors of major adverse cardiovascular events(MACE).Method: 64 patients with ISR were enrolled between March 2014 and November 2015. These patients were treated with either DCB angioplasty(n=46) or DES implantation(n=18). Both group were pre-dilatation with standard balloon catheter, and then use DCB or DES. The DCB had to be inflated for ≥60 seconds. The size of DCB or DES were decided by operators according to the lesion. All patients underwent dual anti-platelet therapy(DAPT) and heparinized before procedure. The patients of DES group underwent DAPT for at least 12 months and DCB group for at least 1 month after procedure. Quantitative coronary analysis(QCA) was conducted after procedure and clinical follow-up was conducted until 6 months.Statistical methods: Statistical analysis was performed by using the SPSS Statistics 17.0. These are presented as the mean and standard deviation for continuous variables. Continuous variables were compared with Students unpaired t-test. Discriminant ariables were evaluated with two-sided Fisher’s exact test. The risk factors of MACE were evaluated with Log-rank test.Result: There is no significant difference of the baseline data between two group(P>0.05). The prevalence of diabetes mellitus patients is higher in DCB group and also the average ages.Pre-procedure reference vessel diameter is smaller in DCB group(2.55±0.39 mm vs 2.98±0.78 mm,P<0.001).After procedure the diameter stenosis of DES group is smaller than DCB group(18.36±7.32 vs 14.15±4.62,P=0.006). After 6 months follow-up there are 13 MACE in DCB group(28.26%, 7 TLR, 3 MI, 3 Death) and 5 MACE in DES group(27.78%, 4 TLR, 1 MI), and there is no significant difference between two group(P = 0.969). And the results show that the reference vessel diameter is the only independent risk factor of MACE(hazard ratio-0.29, 95% confidence interval:-0.524 0.40; P=0.02).Conclusion:(1)Drug coated balloon and drug eluting stent both are safe and effective treatments of in stent restenosis.(2)The reference vessel diameter is the only independent risk factor of MACE.(3)DCB can avoid additional stent implantation and protect normal vessel anatomy, so it is becoming the important strategy in treatment of ISR...