Abstract：
BACKGROUND: Current therapies for pulmonary vein stenosis (PVS) or pulmonary vein total occlusion (PVTO) involving angioplasty and stenting are hindered by high rates of restenosis.
OBJECTIVE: This study compares a novel approach of drug-coated balloon (DCB) angioplasty and stenting with the current standard of care in PVS or PVTO due to pulmonary vein isolation (PVI).
METHODS: A retrospective single-center study analyzed patients with PVS or PVTO due to PVI who underwent either angioplasty and stenting (NoDCB group; December 2012-December 2016) or DCB angioplasty and stenting (DCB group; January 2018-January 2021). Multivariable Andersen-Gill regression analysis assessed the risk of restenosis and target lesion revascularization (TLR).
RESULTS: The NoDCB group comprised 58 patients and 89 veins, with a longer median follow-up of 35 months, whereas the DCB group included 26 patients and 33 veins, with a median follow-up of 11 months. The DCB group exhibited more PVTO (NoDCB: 12.3%; DCB: 42.4%; P = 0.0001), with a smaller reference vessel size (NoDCB: 10.2 mm; DCB: 8.4 mm; P = 0.0004). Follow-up computed tomography was performed in 82% of NoDCB and 85% of DCB, revealing lower unadjusted rates of restenosis (NoDCB: 26%; DCB: 14.3%) and TLR (NoDCB: 34.2%; DCB: 10.7%) in the DCB group. DCB use was associated with a significantly lower risk of restenosis and TLR (HR: 0.003: CI: 0.00009-0.118; P = 0.002).
CONCLUSIONS: The novel approach of DCB angioplasty followed by stenting is effective and safe and significantly reduces the risk of restenosis and reintervention compared with the standard of care in PVS or PVTO due to PVI.
OBJECTIVE: This study compares a novel approach of drug-coated balloon (DCB) angioplasty and stenting with the current standard of care in PVS or PVTO due to pulmonary vein isolation (PVI).
METHODS: A retrospective single-center study analyzed patients with PVS or PVTO due to PVI who underwent either angioplasty and stenting (NoDCB group; December 2012-December 2016) or DCB angioplasty and stenting (DCB group; January 2018-January 2021). Multivariable Andersen-Gill regression analysis assessed the risk of restenosis and target lesion revascularization (TLR).
RESULTS: The NoDCB group comprised 58 patients and 89 veins, with a longer median follow-up of 35 months, whereas the DCB group included 26 patients and 33 veins, with a median follow-up of 11 months. The DCB group exhibited more PVTO (NoDCB: 12.3%; DCB: 42.4%; P = 0.0001), with a smaller reference vessel size (NoDCB: 10.2 mm; DCB: 8.4 mm; P = 0.0004). Follow-up computed tomography was performed in 82% of NoDCB and 85% of DCB, revealing lower unadjusted rates of restenosis (NoDCB: 26%; DCB: 14.3%) and TLR (NoDCB: 34.2%; DCB: 10.7%) in the DCB group. DCB use was associated with a significantly lower risk of restenosis and TLR (HR: 0.003: CI: 0.00009-0.118; P = 0.002).
CONCLUSIONS: The novel approach of DCB angioplasty followed by stenting is effective and safe and significantly reduces the risk of restenosis and reintervention compared with the standard of care in PVS or PVTO due to PVI.
摘要：
背景：涉及血管成形术和支架置入术的肺静脉狭窄（PVS）或肺静脉完全闭塞（PVTO）的当前疗法受到高再狭窄率的阻碍。
目的：本研究比较了一种新型的药物涂层球囊（DCB）血管成形术和支架置入术与目前的PVS或PVTO治疗标准，因为肺静脉隔离（PVI）。
方法：一项回顾性单中心研究分析了因PVI而患有PVS或PVTO的患者，这些患者接受了血管成形术和支架置入术（NoDCB组；2012年12月至2016年12月）或DCB血管成形术和支架置入术（DCB组；2018年1月至2021年1月）。多变量Andersen-Gill回归分析评估了再狭窄和靶病变血运重建（TLR）的风险。
结果：NoDCB组包括58名患者和89条静脉，中位随访时间为35个月，而DCB组包括26名患者和33条静脉，中位随访时间为11个月。DCB组表现出更多的PVTO（NoDCB：12.3％；DCB：42.4％；P=0.0001），参考血管尺寸较小(NoDCB:10.2mm;DCB:8.4mm;P=0.0004)。在82％的NoDCB和85％的DCB中进行了后续计算机断层扫描，DCB组的未调整再狭窄率(NoDCB:26%;DCB:14.3%)和TLR(NoDCB:34.2%;DCB:10.7%)较低.使用DCB与再狭窄和TLR的风险显著降低相关(HR:0.003:CI:0.00009-0.118;P=0.002)。
结论：与PVS或PVTO因PVI的标准治疗相比，DCB血管成形术后支架置入的新方法是有效和安全的，并且显著降低了再狭窄和再干预的风险。
目的：本研究比较了一种新型的药物涂层球囊（DCB）血管成形术和支架置入术与目前的PVS或PVTO治疗标准，因为肺静脉隔离（PVI）。
方法：一项回顾性单中心研究分析了因PVI而患有PVS或PVTO的患者，这些患者接受了血管成形术和支架置入术（NoDCB组；2012年12月至2016年12月）或DCB血管成形术和支架置入术（DCB组；2018年1月至2021年1月）。多变量Andersen-Gill回归分析评估了再狭窄和靶病变血运重建（TLR）的风险。
结果：NoDCB组包括58名患者和89条静脉，中位随访时间为35个月，而DCB组包括26名患者和33条静脉，中位随访时间为11个月。DCB组表现出更多的PVTO（NoDCB：12.3％；DCB：42.4％；P=0.0001），参考血管尺寸较小(NoDCB:10.2mm;DCB:8.4mm;P=0.0004)。在82％的NoDCB和85％的DCB中进行了后续计算机断层扫描，DCB组的未调整再狭窄率(NoDCB:26%;DCB:14.3%)和TLR(NoDCB:34.2%;DCB:10.7%)较低.使用DCB与再狭窄和TLR的风险显著降低相关(HR:0.003:CI:0.00009-0.118;P=0.002)。
结论：与PVS或PVTO因PVI的标准治疗相比，DCB血管成形术后支架置入的新方法是有效和安全的，并且显著降低了再狭窄和再干预的风险。
