Abstract：
Slow-flow or no-reflow phenomenon is a common procedural complication during percutaneous coronary intervention (PCI). Given the presence of fragile plaque or thrombotic materials, we hypothesized that long-time predilatation using a perfusion balloon in conjunction with intracoronary nicorandil administration reduces the risk of slow-flow or no-reflow in patients presenting with acute coronary syndrome (ACS). Subjects were patients presenting with ACS who underwent PCI between April 2020 and April 2022. We retrospectively investigated the incidence of slow-flow or no-reflow during the procedure as well as in-hospital outcomes in comparison between the cases undergoing 3-min predilatation using a perfusion balloon in conjunction with intracoronary nicorandil administration followed by DES implantation (PB group) and those with direct stenting (DS group). Among 439 ACS patients, 36 patients in the PB group and 51 patients in the DS group were examined. Mean age was 70 years and 78.2% was male. Distal protection devices were more frequently used in the DS group than in the PB group (31.3% vs. 11.1%, p = 0.02). The incidence rate of slow-flow or no-reflow was significantly lower in the PB group than in the DS group (2.8% vs. 23.5%; p < 0.01). Six cases (11.7%) in the DS group required intra-aortic balloon pumping (IABP), while none in the PB group required (p < 0.01). In-hospital clinical outcomes did not differ between the two groups. Prolonged perfusion balloon predilatation in conjunction with intracoronary nicorandil administration was safe and feasible. This novel strategy could be an attractive alternative to conventional direct stenting for ACS patients.
摘要：
慢血流或无复流现象是经皮冠状动脉介入治疗（PCI）过程中常见的手术并发症。鉴于存在脆弱的斑块或血栓材料，我们假设,在急性冠脉综合征(ACS)患者中,长期使用灌注球囊预扩张联合冠状动脉内尼可地尔能降低慢血流或无复流的风险.受试者是在2020年4月至2022年4月期间接受PCI的ACS患者。我们回顾性调查了使用灌注球囊联合冠状动脉内尼可地尔预扩张3分钟，然后再植入DES的病例（PB组）和直接支架置入的患者（DS组）之间的比较，比较了手术过程中慢流或无复流的发生率以及院内结局。在439名ACS患者中，检查PB组36例患者和DS组51例患者。平均年龄70岁，78.2%为男性。DS组比PB组使用远端保护装置更频繁(31.3%vs.11.1%,p=0.02)。PB组慢流或无复流的发生率明显低于DS组（2.8％vs.23.5%；p<0.01)。DS组6例（11.7%）需要主动脉内球囊反搏（IABP），而PB组没有要求(p<0.01)。两组的住院临床结果没有差异。长期灌注球囊预扩张术与冠状动脉内尼可地尔给药相结合是安全可行的。这种新策略可能是ACS患者常规直接支架置入术的有吸引力的替代方案。
