Carotid Angioplasty with Cutting Balloon Yields Low Complication Rates

      Shane Gieowarsingh说：“纤维钙化的颈动脉病变应用切割式球囊血管成形术，其中期观测结果令人振奋。使用该技术治疗的111例患者，其技术成功率可达100%（限定在支架置入后残余再狭窄率<30%）”。

      研究者对这些颈动脉狭窄的患者（37例有症状的患者狭窄率≥50%，74例无症状的患者狭窄率≥80%）平均随访17个月。

      在30例患者（27%）中用低压球囊扩张后置入切割式球囊。对所有的111例患者使用5.0/5.5-mm球囊加阿托品行后扩张（如图）。在随后的30内发生中风合并死亡率为0.9%，其中15天时有一例患者发生严重中风。在随访期间，4例患者死亡（3.6%）；2例癌症相关的，1例是急腹症，1例不详。后续随访过程中，未有发生中风或再狭窄。

      Gieowarsingh认为利用切割式球囊导管可改善斑块的弹性和纤维变性的连续性，从而降低压力使球囊扩张，获得最大管腔直径。

      Gieowarsingh承认这项研究存在局限性，包括斑块钙化的半定量估值和需要完成两年的随访工作，他说：“但是，中期随访发现，在患有严重钙化病变的单支血管病变患者通过切割式球囊血管成形术获得成功并且并发症率比较低的结果是令人振奋的，它的意义在于扩大了颈动脉支架的适用人群。”

（医心评论 朱静 译 马秀芹 校）

Carotid Angioplasty with Cutting Balloon Yields Low Complication Rates

Key Points:

• Longer and more complete follow-up is needed

By TCT Daily Staff

Mid-term results from an observational study of cutting balloon angioplasty for fibrocalcific carotid artery lesions were encouraging, according to Shane Gieowarsingh, MD, an interventional cardiologist at the University Hospitals of Leicester in the United Kingdom.

Gieowarsingh reported 100% technical success (defined as stent implantation and residual stenosis <30%) in 111 patients undergoing treatment using the Cutting Balloon catheter (Boston Scientific).

The researchers enrolled patients with carotid artery stenosis (37 symptomatic with ≥50% stenosis and 74 asymptomatic with ≥80% stenosis) into the study with a mean follow-up of 17 months.

Dilatation with a low-profile coronary balloon to facilitate passage of the Cutting Balloon occurred in 30 (27%) patients. Post-dilatation with a 5.0/5.5-mm balloon plus atropine per protocol was achieved in all 111 patients (see Figure).

The combined stroke and death rate at 30-day follow-up was 0.9%, with one major stroke reported at day 15.

Four deaths were recorded during follow-up (3.6%): two were cancer-related, one was an abdominal emergency, and one was unclassified. No stroke or restenosis was reported during subsequent follow-up.

Gieowarsingh hypothesized that the use of the Cutting Balloon catheter could modify the elasticity and fibrotic continuity of plaque, thereby reducing the amount of pressure needed to inflate the noncompliant balloon to achieve luminal gain.

Gieowarsingh acknowledged limitations of the study, which included the semi-quantitative assessment of plaque calcification and the need for complete two-year follow-up.

"The results obtained with cutting balloon angioplasty in this cohort with severe calcific de novo carotid disease are encouraging in terms of high technical success and low complication rates along with durable results in the mid-term," he said. "This is significant because it broadens the population of patients suitable for carotid stenting."

Disclosures:

（source：www.tctmd.com）