Lemos Pedro A, Saia Francesco, Ligthart Jurgen M R, Arampatzis Chourmouzios A, Sianos Georgios, Tanabe Kengo, Hoye Angela, Degertekin Muzaffer, Daemen Joost, McFadden Eugene, Hofma Sjoerd, Smits Pieter C, de Feyter Pim, van der Giessen Willem J, van Domburg Ron T, Serruys Patrick W
Erasmus Medical Center, Thoraxcenter, Bd-406, Dr Molewaterplein 40, 3015-GD Rotterdam, The Netherlands.
Circulation. 2003 Jul 22;108(3):257-60. doi: 10.1161/01.CIR.0000083366.33686.11. Epub 2003 Jul 14.
We describe the clinical and morphological patterns of restenosis after sirolimus-eluting stent (SES) implantation.
From 121 patients with coronary angiography obtained >30 days after SES implantation, restenosis (diameter stenosis >50%) was identified in 19 patients and 20 lesions (located at the proximal 5-mm segment in 30% or within the stent in 70%). Residual dissection after the procedure or balloon trauma outside the stent was identified in 83% of the proximal edge lesions. Lesions within the stent were focal, and stent discontinuity was identified in some lesions evaluated by intravascular ultrasound.
Sirolimus-eluting stent edge restenosis is frequently associated with local trauma outside the stent. In-stent restenosis occurs as a localized lesion, commonly associated with a discontinuity in stent coverage. Local conditions instead of intrinsic drug-resistance to sirolimus are likely to play a major role in post-SES restenosis.
我们描述了西罗莫司洗脱支架（SES）植入术后再狭窄的临床和形态学模式。
在121例SES植入术后30天以上进行冠状动脉造影的患者中，19例患者和20处病变（30%位于近端5毫米节段，70%位于支架内）被确定为再狭窄（直径狭窄>50%）。83%的近端边缘病变在术后发现有残余夹层或支架外球囊损伤。支架内病变为局灶性，血管内超声评估的一些病变中发现有支架中断。
西罗莫司洗脱支架边缘再狭窄常与支架外局部损伤有关。支架内再狭窄表现为局限性病变，通常与支架覆盖不连续有关。局部情况而非对西罗莫司的内在耐药性可能在SES术后再狭窄中起主要作用。
