药物涂层球囊在下肢闭塞性动脉硬化微创介入治疗中的临床应用OA

Objective:To evaluate the clinical efficacy and safety of drug-coated balloons(DCB)in the minimally invasive interventional treatment for lower extremity arteriosclerosis obliterans(ASO),and to conduct a comparative analysis with percutaneous transluminal angioplasty(PTA)and bare-metal stent(BMS)implantation.Methods:One hundred ASO patients were selected as the study subjects and randomly divided into a DCB group(35 cases,with paclitaxel-coated balloons treatment),a PTA group(33 cases,with conventional balloon angioplasty),and a BMS group(32 cases,with BMS implantation).The minimum lumen diameter(MLD),ankle-brachial index(ABI)before and after surgery were compared among the three groups.And the intragroup and intergroup differences in ABI,MLD,late lumen loss(LLL)and Rutherford classification improvement rates at 3,6,12 months after surgery were compared.The one-stage vascular patency rate was analyzed using Kaplan-Meier survival analysis and Log-rank test.The rates of restenosis,target lesion revascularization,one-stage vessel patency,amputation and all-cause mortality among the three groups at 12 months after surgery were compared.Results:The success rate of the 100 surgeries was 98.0%.Immediately after the surgery,the MLD and ABI in all three groups increased significantly compared to before the surgery(all P＜0.01),while no difference among the three groups was found(P＞0.05).At 3 months after the surgery,the ABI,MLD and Rutherford classification improvement rate in the DCB group and the BMS group were all higher than those in the PTA group,while the LLL was lower than that in the PTA group(all P＜0.05),however,there were no statistically significant differences between the DCB group and the BMS group.At 6 months after the surgery,the ABI,MLD and Rutherford classification improvement rate in the DCB group and the BMS group were all higher than those in the PTA group,while the LLL was lower than that in the PTA group(all P＜0.05),however,there were statistically significant differences in MLD and LLL between the DCB group and the BMS group(both P＜0.05),and ABI had no difference(P>0.05).At 12 months after the surgery,the ABI,MLD and Rutherford classification improvement rate in the DCB group and the BMS group were all higher than those in the PTA group,while the LLL was lower than that in the PTA group(all P＜0.05),and there were statistically significant differences between the DCB group and the BMS group(all P＜0.05).Compared with the PTA group and the BMS group,the DCB group had the higher one-stage vascular patency rate and the lower rates of restenosis,target lesion revascularization(all P＜0.05),and the rate of target lesion revascularization among the three groups had a statistically significant difference(P＜0.05).Conclusions:DCB demonstrate significant advantages in maintaining long-term vascular patency for the treatment of lower extremity ASO.It can effectively inhibit intimal hyperplasia,reduce the risk of restenosis and re-intervention,and exhibit a favorable safety profile.It is particularly suitable for long-segment lesions and anatomical locations where stent implantation is preferably avoided.