The Challenge of Percutaneous Coronary Intervention in Small Vessels

摘要

Significant coronary artery disease (CAD) occurring in small vessels (typically defined as <2.8 mm reference diameter) is not an uncommon finding during cardiac catheterization and represents one-third of percutaneous coronary intervention (PCI) procedures. The current options of treatment by PCI include plain balloon angioplasty, drug coated balloons (DCB) and stents. The size of the coronary vessel is an important determinant of outcome following PCI. Neointimal proliferation following stent deployment is relatively independent of the vessel size, and thus results in greater late lumen loss in the small caliber coronary arteries. Though drug-eluting stents (DES) inhibit neointimal proliferation, small vessel disease is a significant predictor of adverse clinical events even with the new generation DES. The DCB is an attractive alternative for de novo lesions occurring in small coronary arteries, with encouraging results. The DCB negates the late lumen loss seen with stents, and potentially eliminates the risk of chronic inflammation in the absence of a metallic stent and polymer. The long-term follow-up of treatment of small vessel CAD with DCB has shown acceptable clinical outcomes at 3 years