The Analysis Of Different Types Of Risk Factors For In-stent Restenosis In Coronary Artery And The Curative Effect Of Different Intervention Methods For Coronary Artery In-stent Restenosis In Clinical Follow-up

Part ? The Analysis of different types of risk factors for in-stent restenosis in coronary artery Objective:The objective of the study was to explore the related factors of coronary artery in-stent restenosis.Methods: Coronary angiography was performed in our hospital from January 2012 to June 2017 in 50 cases.The results indicated that it was ISR.According to Mehran classification,it was divided into Type ?(7 cases),Type ?(17 cases),Type ?(22 cases)and Type ?(4 cases).To compare the clinical data,biochemical indexes and coronary angiography characteristics of 4 groups of patients.Results: In 50 patients,there was no significant difference in sex,hypertension,diabetes and blood lipid among the patients.From coronary angiography,there was no significant difference between the branches,multiple lesions,coronary calcification and stent diameter.The greater the severity of the lesions and the longer the total length of the stent,the greater the degree of restenosis.Conclusions: The severity of the stenosis and the total length of stent may be related to the type of restenosis.Part ? The curative effect of different intervention methods for coronary artery In-stent restenosis in clinical follow-upObjective: The objective of the study was to evaluate the curative effect different among the treatment of ISR with DES,DCB,BA and drug therapy.Methods: The patients who had coronary heart disease and underwent repeated PCI for in-stent restenosis from January 2012 to June 2017 were enrolled in this study.According to the intervention methods,29 cases were treated with stent implantation,9 cases with drug-elution balloon,12 cases with balloon dilation and drug therapy;The degree of coronary artery disease before stent implantation was divided into three groups: 1-27(15 cases with mild coronary stenosis),28-50(22 cases with moderate coronary stenosis)and 51-152(13 cases with severe coronary stenosis);< 20 mm group(33 cases)and >20 mm group(17 cases)according to lesions vessel length.According to coronary angiography after stent implantation,there were 4 groups of re-stenosis(ISR degree): <50 %(2 cases),50 %-75 %(6 cases),75 %-90 %(14 cases)and >90 %(28 cases).Drug therapy and high-pressure balloon dilatation were performed in patients with type ? and part of type ? lesions with light stenosis,short lesion and in-stent restenosis.For the patients with severe stenosis,long lesion and in-segment restenosis,the use of repeated DES or DCB depended on the operator and the results of balloon dilation.All patients were prospectively followed up for major adverse cardiovascular event during hospitalization,chest pain recurrence,death,target lesion revascularization,stent thrombosis.Results: Analysis of lesion length and severity of pre-implantation lesions showed that non-focal lesions(type ?,type ?,and type ?)occurred more frequently than focal types(type ?)(P< 0.05);The more serious vascular lesions before stent implantation,the greater the incidence of non-focal lesions than that of focal type(P<0.05);the focal lesions were mainly balloon dilatation and enhanced drug therapy,of which 5 cases were balloon dilation,1 case was drug therapy(patient refused PTCA and requested medication),1 case was drug-eluting balloon(with high vascular lesions);most non-focal-type stents were implanted with repeated DES or drug-eluting balloon,among which 4 patients were non-focal and severely stenotic.Individuals who refused to undergo PCI were selected for drug treatment.A small number of lesions given balloon dilation and enhanced drug treatment,the results suggest a statistical difference(P <0.01).Follow-up found no significant difference in major adverse cardiac events,TLR,chest pain recurrence,and mortality between the four groups(P>0.05).Conclusions: The treatment strategy for in-stent restenosis based on the severity and type of restenosis is effective.balloon dilation or drug therapy is appropriate for the mild and focal in-stent restenosis,while repeated DES implantation or drug-eluting balloon may be a better choice for the severe and non-focal in-stent restenosis.