Drug balloons: an alternative to heart stents?

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Drug balloons: an alternative to heart stents?

With the continuous accumulation of experience in drug balloon surgery, more and more interventional cardiologists have realized that the same drug balloon treatment has a very different effect. Why is this?

Heart stents must be familiar to everyone. With the continuous development of medical technology, generations of drug stent designs and processes have matured.

Severely narrowed heart vessels can regain patency after heart stent surgery, saving many lives. But the heart stent is an “foreign species” for the human body after all, so at the beginning of this century German doctors invented a drug balloon.

What is a drug balloon?

A drug balloon is a balloon that carries a drug similar to a drug stent.

When performing minimally invasive cardiac interventional surgery, similar to drug stents, doctors must first pre-treat the narrow and blocked blood vessels, which is what everyone says to dredge the blood vessels.

The difference is that the drug stent will finally stay in the human blood vessel to play a supporting role, and the drug balloon will be attached to the diseased blood vessel for about 60 seconds.

After the drug carried and the blood vessel are fully functional, Just withdraw from the body without leaving foreign objects in the body.

At present, a large number of studies have shown that drug balloons have more advantages than drug stents in cases of restenosis, small vessel disease (vessel diameter ≤2.75mm), and bifurcation disease in the stent.

A drug balloon is a balloon that carries a drug similar to a drug stent.

What are the advantages of drug balloons?

Judging from the research data at home and abroad over the years and our own use experience, there are mainly the following points:

1. No foreign body, drug balloon

After surgery, the time required to take dual antiplatelet (aspirin+clopidogrel or ticagrelor) is greatly shortened, and only the combined use of drugs is required for 1-3 months; while the drug stent implantation generally takes 12 months.

2. Low bleeding risk,

Due to the short time required to take aspirin and clopidogrel (or ticagrelor) in combination, the bleeding risk is greatly reduced, and it is suitable for people with high bleeding risk.

3. It is more friendly to those who need surgery with severe stenosis of the heart vessels and surgical diseases.

Patients with severe coronary artery stenosis requiring interventional surgery can receive surgery at least 12 weeks after stent surgery, and surgery can be performed at least 1 month after drug balloon surgery (Note: Surgical emergency surgery is excluded).

4. Better retention of blood vessel elasticity.

A stent is implanted after the vascular stenosis, the vascular stenosis is resolved, and the danger is relieved, but the elasticity of the blood vessel of the remaining stent will be reduced, especially in the case of long stents and multiple stents.

However, the elasticity of blood vessels for restenosis in the stent and the re-implantation of the stent in the original position is significantly reduced.

Because the drug balloon does not retain foreign bodies, the elasticity of the blood vessel is better.

This is also an important reason for the first choice of drug balloon treatment after in-stent restenosis.

Which situations are more suitable for the use of drug balloons?

Based on the current post-marketing clinical observation data on drug balloons, drug balloons have achieved good clinical effects, especially in the following situations:

1. Recurrent stenosis and blockage in the original stent:

Although the incidence of restenosis of a new generation of stents is only 3-5%, re-implantation of stents after restenosis is often not effective, and drug balloons are the best choice for in-stent restenosis.

There is currently a large amount of data supporting in-stent restenosis Using drug balloons;

2. Small vessel disease:

Small vessel disease (vessel diameter ≤2.75mm) has a high incidence of restenosis after stent implantation. Current data show that the drug balloon has a better effect;

3. Bifurcation lesions:

For stenosis at the bifurcation of blood vessels, double stents (such as Crush or Culotte) were often used in the past.

The operation is more complicated, and the incidence of in-stent restenosis is relatively high after surgery.

The main branch is implanted with a drug stent, and the branch uses a drug balloon, which can greatly simplify the operation method and reduce the operation time.

Current data also show that this operation has more advantages.

4. Patients with high risk of bleeding or requiring surgery in the near future:

Coronary heart disease requires conventional drug treatment. After stent surgery, dual antiplatelet (usually aspirin + clopidogrel) treatment is required for one year.

Even if surgery is required or there is a high risk of bleeding, aspirin + clopidogrel is generally required 3 months.

However, after the drug balloon surgery, the shortest time to take aspirin + clopidogrel is 4 weeks, and the surgery can be stopped after 4 weeks.

5. Other:

Macrovascular disease, chronic occlusive disease, there are also some current studies that support the use of drug balloon therapy, data show that the effect is equivalent to or better than stent implantation.

What conditions are not suitable for the use of drug balloons?

The drug balloon has so many advantages, is it suitable for any severe vascular stenosis? the answer is negative.

During minimally invasive intervention in severely narrowed blood vessels, doctors will pre-treat the lesions.

If the residual vascular stenosis is greater than 30%, or the blood vessel forms a severe dissection, which affects the blood flow of the blood vessel, then the drug balloon has to stand aside and need to Use drug stents to solve the above problems.

How to get better curative effect?

Accurate assessment is important

Interventional cardiologists need to accurately assess the patient’s coronary arteries. In addition to careful coronary angiography before drug balloon treatment, intravascular ultrasound (IVUS) is necessary for most patients.

Intravascular ultrasound examination can allow the surgeon to better understand the structure of the blood vessel, the characteristics of the plaque at the vascular stenosis, whether it is a lipid plaque, fibrous plaque, or calcified plaque, so that the doctor can understand the next operation strategy. chest.

Adequate pretreatment is the key

Almost all interventional cardiologists have realized that adequate blood vessel pretreatment is the key to the efficacy of surgery before drug balloon treatment.

This is also the significance of intravascular ultrasound before drug balloon treatment:

If the intravascular ultrasound shows that the coronary artery stenosis is mainly lipid plaque, it can be pretreated by ordinary balloon according to the blood vessel size.

But if it is mainly fibrous plaque or calcified plaque, it is necessary to perform repeated and meticulous treatment of cutting balloon and non-compliant balloon. The blade on the cutting balloon cuts the fibrous ring or calcification of the plaque in order to get the medicine The drugs carried by the balloon have a good effect on blood vessels.

If the intravascular ultrasound shows severe calcification of the intima of the plaque, cutting balloons and non-compliant balloons are not enough. At this time, the advanced weapon of the interventional cardiologist-the rotational atherectomy device is needed. The rotational atherectomy instrument has a diamond-encrusted rotational atherectomy head, at a speed of 120,000-180,000 rpm, the severely calcified plaques are polished into particles below 10μm. These particles are fine enough not to block the capillaries. Eventually it returns to the blood circulation and is cleaned by a “human body” called the reticuloendothelial system, which is “rotation atherectomy”. Rotary atherectomy can make the body’s severely calcified heart and blood vessel walls smoother, and the drug balloon has a more adequate effect, and it is not easy to form a thrombus.

Precise operation of doctors and active cooperation of patients are very important

At present, most of the drugs carried by drug balloons in clinical use are fat-soluble.

The time for the drug balloon to be delivered to the vascular lesion should not be too long; the time for the drug balloon to act on the vascular lesion should not be less than 30 to 60 seconds.

Under close observation, the general balloon expansion time is 60 seconds.

Of course, in addition to the above-mentioned technical details related to surgery, patients with coronary heart disease adhere to a good lifestyle (such as quitting smoking, controlling diet, exercise, etc.) and maintaining related medications are also important guarantees for better effect of drug balloon surgery.

In summary, drug balloon is a method to replace drug stents in the treatment of coronary heart disease.

At present, various heart centers at home and abroad have accumulated more experience, and gradually use drug balloon treatment in the application of drug stents.

According to current research and observation data, drug balloons can replace most of the application scenarios of drug stents.