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目的 :探讨预扩张球囊导管的选择对支架置入操作的影响。方法 :将内径≥ 3.0mm的前降支开口以远病变 (长度≤ 2 0mm、狭窄 80 %～ 99%、中度以下钙化、TIMIⅡ～Ⅲ级、近端弯曲≤ 4 5°)的患者 5 0例随机分为 2 .0mm、2 .5mm和 3.0mm球囊预扩张组 ,采用同一品牌的指引导管、导丝和球囊导管进行预扩张 ,观察球囊充盈程度、球囊通过病变率、TIMI血流率和夹层发生率。对达到支架样扩张效果者结束操作 ,其他病变均置入相同品牌的预装混合支架并观察 :支架到位率、球囊充盈程度、近端血管直径与球囊直径、残余狭窄程度、TIMI改善率。结果 :各组预扩张压力和时间差异无显著性意义 (P >0 .0 5 )。与 2 .5mm球囊组相比 ,2 .0mm球囊组预扩张后TIMI改善率低、支架不能通过病变率高 (均P <0 .0 5 ) ;与 2 .5mm球囊组相比 ,3.0mm球囊组的TIMI改善率、支架通过率虽然较高 ,但血管夹层的发生率亦明显增加 (P <0 .0 5 ) ;对直径 3.0mm的病变血管采用 2 .5mm球囊预扩张夹层发生率低、支架通过率高、TIMI改善率适中。结论 :预扩张操作最好选用比病变血管内径小10 %～ 2 0 %的球囊 ,如此可达到较好的预扩张效果、便于支架到位 ,同时又不至于明显加重血管损伤或造成新的需要处理的血管夹层。
Objective: To investigate the effect of pre-dilatation balloon catheter selection on stent placement. Methods: The anterior descending branch opening with internal diameter ≥ 3.0 mm was treated with distal lesion (length ≤ 20 mm, stenosis of 80% -99%, calcific of moderate degree, grade Ⅲ ~ Ⅲ, proximal curvature ≤ 45 °) Cases were randomly divided into 2.0mm, 2.5mm and 3.0mm balloon pre-dilation group, using the same brand of guide catheter, guide wire and balloon catheter pre-dilatation, balloon filling degree, the balloon through the lesion rate, TIMI Blood flow rate and incidence of dissection. To reach the end result of stent-like dilatation operation, the other lesions were placed under the same brand of pre-mixed stent and observe: stent placement rate, balloon filling degree, proximal vascular diameter and balloon diameter, residual stenosis, TIMI improvement rate . Results: There was no significant difference in pre-dilation pressure and time in each group (P> 0.05). Compared with the 2.5mm balloon group, the rate of improvement of TIMI was low and the stent could not pass the high rate of lesion in the 2.0mm balloon group (all P <0.05). Compared with 2.5mm balloon group, 3.0mm balloon group TIMI improvement rate, although the stent through rate higher, but the incidence of vascular dissection also significantly increased (P <0. 05); diameter of 3.0mm vascular lesions using 2.5mm balloon pre-dilatation Low incidence of dissection, stent through rate, TIMI improvement rate is moderate. CONCLUSIONS: Pre-dilatation is best to use balloons smaller than the vascular diameter of the lesion by 10% to 20%, so that a good pre-dilatation effect can be achieved and the stent can be placed in place without significantly exacerbating the vascular damage or causing new needs Treatment of vascular dissection.