Clinical Efficacy Of Drug-coated Balloon With The Second Generation Of Drug Eluting Stents In The Treatment Of Coronaryartery In-stent Restenosis

Objective:To compare the efficacy and safety of drug coated balloon and the second generation drug eluting stent in the treatment of patients with coronary artery in-stent restenosis.Methods:The study analyzed 49 cases of patients admitted to the second hospital affiliated to zhejiang university school of medicine from January 2016 to December 2016 for coronary artery stent implantation,who were admitted to the hospital for re-examination because of "angina pectoris" or no symptoms,who were confirmed as stent restenosis by coronary angiography,and were divided into two groups according to the opinions of the operators or family members.29 cases were treated with drug-coated balloon therapy and 20 cases with the second generation drug eluting stents.The data of patients' perioperative angina symptoms,Serum myocardial enzymes,vascular stenosis rate,the minimum endovascular diameter,and the vascular stenosis rate and the minimum endovascular diameter at the 6-12 months of angiography review were collected,and the occurrence of major cardiovascular adverse events within 12 months after outpatient or telephone follow-up were conducted.The data were statistically analyzed using Graphpad Prism 5.0 statistical software.The surgical success rate,immediate postoperative stenosis rate changes,lumen diameter changes,perioperative symptom improvement,perioperative Serum myocardial enzymes changes,intra-segmental loss of late lumen,and the incidence rate of major cardiovascular adverse events(MACE)were observed in the two groups.Results:1.The 49 patients selected in this study performed well in the process of general balloon predilation without dissection affecting blood flow,and were successfully treated for restenosis with drug-coated balloon or the second generation drug eluting stents.The immediate success rate of interventional surgery in both groups was 100%.2.The patients in the two groups showed significant immediate benefit after surgery,and the postoperative degree of immediate stenosis was significantly reduced compared with that before surgery.In the DES group(14.55± 1.35%vs 84.65±2.50%,p<0.01)and DCB group(14.79± 1.31%vs 82.48± 1.98%,p<0.01),the minimum lumen diameter was significantly increased after surgery compared with that before surgery.p<0.01]and DCB group[0.56 ± 0.05mm vs 2.31 ±0.09mm,P<0.01].Postoperative symptoms improved significantly.Comparison between preoperative postoperative group,lesions in patients with minimal lumen diameter stenosis degree contrast no statistical difference,pathological changes,reduce postoperative stenosis rate,postoperative lumen diameter size and length increase,drug balloon compared the two groups had no statistical difference(p>0.05),and the maximum expansion pressure DES group is higher than the DCB[11.60±1.75atm vs 9.90±1.99atm,p<0.01).Preoperative and postoperative myocardial enzyme spectra were not significantly increased,and there was no significant difference between the two groups(p>0.05).3.According to the average review time of about 9 months postoperatively,there were no statistically significant differences in the minimum lumen diameter,stenosis,late vascular loss,and stenosis rate changes between the DCB group and the DES group(p>0.05),and there were no differences in late vascular loss(0.23±0.07 vs.0.22±0.07,P=0.89).4.Patients with MACE and secondary endpoint events at 12 months were tracked through outpatient or telephone follow-up.No statistical difference was found between the two groups.In the DES group,there were 3 cases of MACE3,including 1 case of cardiogenic death,and including 1 case of non-fatal myocardial infarction,2 cases of target lesion revascularization.In the DCB group,there were 4 cases of MACE4,including 1 case of cardiogenic death,2 cases of non-fatal myocardial infarction,and 2 cases of target lesions.There was no statistical difference in the incidence of MACE between the two groups(15.00%vs 13.79%,p=0.73).5.No adverse cardiovascular events occurred during perioperative period in the DCB group.After the preoperative stent implantation in the DES group,1 case of acute myocardial infarction was caused by compression of the middle branch,which resulted in acute myocardial infarction.Again,PTCA was given for treatment of the middle branch,and the postoperative blood flow was restored and symptoms were relieved.Conclusion:1.In the strategy selection for the treatment of restenosis in coronary artery stents,compared with the second generation drug eluting stents,the success rate of immediate surgery used drug-coated balloon is 100%,with significant immediate benefits,good safety during perioperative period,and no adverse cardiovascular events.2.Angiographic review was performed at 6-12 months after surgery(9.18±3.87 months on average).Compared with drug-coated balloon and the second generation drug eluting stent in the treatment of restenosis in stents,there was no significant increase in the loss of vessels in the late stage of lesion.3.After 12 months of clinical follow-up,there was no significant difference in the incidence of major adverse cardiovascular events between the two treatment strategies,and the two strategies were equally safe.