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Objective:To investigate the safety and efficacy of interventional therapy with balloon predilation of different diameters in severe carotid artery stenosis.Methods:One hundred patients with symptomatic severe carotid artery stenosis admitted to our hospital from January 2018 to September 2018 were selected. These patients were randomly divided into 4 mm balloon predilation group and 5 mm balloon predilation group ( n=50). The surgical success rate, residual stenosis rate, changes of heart rate and blood pressure before and after surgery, and complications were compared between the two groups. Results:The success rate of surgery in both groups was 100%. The average preoperative vascular stenosis rate in the 4 mm balloon predilation group was (84.8±8.6)%, and postoperative residual stenosis rate was (12.2±6.2)%, with significant difference ( P<0.05); in the 5 mm balloon predilation group, the average preoperative vascular stenosis rate was (82.1±8.0)%, and the postoperative residual stenosis rate was (6.4±6.1)%, with significant difference ( P<0.05). The postoperative residual stenosis rate of the 5 mm balloon predilation group was significantly lower than that of the 4 mm balloon predilation group ( P<0.05). In the 4 mm balloon predilation group, systolic blood pressure decreased by (19.8±22.3) mmHg and heart rate decreased by (11.0±9.7) times/min; the systolic blood pressure decreased by (14.0±28.5) mmHg and heart rate decreased by (7.0±10.8) times/min in the 5 mm balloon predilation group; no significant differences were noted between the two groups in blood pressure and heart rate ( P>0.05). Complications was noted in 28 patients from the 4 mm balloon predilation group and 25 patients from the 5 mm balloon predilation group, without statistical difference ( P>0.05). Conclusion:The application of the two kinds of diameter balloon in the interventional treatment of severe carotid artery stenosis is safe and effective, and the short-term improvement efficay of 5 mm balloon predilation is better than that of 4 mm balloon predilation.
RESUMEN
BACKGROUND: There is no efficient and unified optimal scheme for treating coronary bifurcation diseases. Simple strategies such as drug-eluting stent implantation in the main branch and drug-coated balloon dilation in the sub-branches are mostly adopted. However, direct drug-coated balloon dilation cannot overcome the problem of elastic retraction of vascular wall, and there is still a risk of branch loss in the long term. OBJECTIVE: To investigate the efficacy and safety of a cutting balloon versus a semi-compliant balloon for predilation of coronary bifurcation lesions. METHODS: From August 2016 to May 2018, 110 patients with coronary bifurcation lesions admitted at Jiaozuo People’s Hospital were selected, including 83 males and 27 females, aged 18-88 years. The patients were randomized into observation and control groups (n=55/group) and received percutaneous coronary intervention. The main branch in the observation group was predilated by a cutting balloon prior to drug-eluting stent implantation, and the sub-branches were predilated by a cutting balloon prior to drug-coated balloon dilation. The main branch in the control group was predilated by a semi-compliant balloon prior to drug-eluting stent implantation, and the sub-branches were predilated by a semi-compliant balloon prior to drug-coated balloon dilation. Immediate postoperative angiography was performed to determine the forward blood flow TIMI grading of main branches and sub-branches and whether vascular dissection occurred. Coronary angiography quantitative analysis was used to detect the reference diameter, minimum inner diameter and stenosis degree of main and sub-branches before, immediately, 6 and 12 months after surgery. Major cardiovascular adverse events within 12 months after surgery were recorded in both groups. The study was approved by the Ethics Committee of Jiaozuo People’s Hospital. RESULTS AND CONCLUSION: (1) Immediate postoperative angiography showed that the TIMI level 3 rate of the main branches and sub-branches in the observation group was higher than that in the control group (P=0.007, 0.015), the incidence of vascular dissection was lower than that in the control group (P=0.023, 0.012), and the emergency target vessel reconstruction rate was lower than that in the control group (P=0.006, 0.026). (2) The success rate of coronary artery maintenance immediately and at 6 and 12 months after surgery in the observation group was higher than that in the control group (all P < 0.001). (3) The minimum inner diameter of main branches and sub-branches in the observation group was larger than that in the control group immediately and at 6 and 12 months after surgery (all P < 0.01). The degree of inner diameter stenosis was smaller than that in the control group (all P < 0.01). (4) The target vessel restenosis rate of main branch and sub-branches in the observation group was lower than that in the control group within 12 months after surgery (P=0.038, 0.043). The incidence of major cardiovascular adverse events was lower than that in the control group (P=0.025). (5) These results indicate that in coronary bifurcation lesions, drug-eluting stent implantation is suitable for main branch lesions and drug coated balloon is suitable for sub-branch lesion. Cutting balloon predilation is safer and more effective than semi-compliant balloon predilation. Cutting balloon predilation can also reduce the rate of target restenosis and the incidence of major cardiovascular adverse events.