西罗莫司洗脱支架植入治疗支架内再狭窄后，支架扩张不足对复发的影响。
Contribution of stent underexpansion to recurrence after sirolimus-eluting stent implantation for in-stent restenosis.
作者信息
Fujii Kenichi, Mintz Gary S, Kobayashi Yoshio, Carlier Stéphane G, Takebayashi Hideo, Yasuda Takenori, Moussa Issam, Dangas George, Mehran Roxana, Lansky Alexandra J, Reyes Arlene, Kreps Edward, Collins Michael, Colombo Antonio, Stone Gregg W, Teirstein Paul S, Leon Martin B, Moses Jeffrey W
机构信息
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, NY 10021, USA.
出版信息
Circulation. 2004 Mar 9;109(9):1085-8. doi: 10.1161/01.CIR.0000121327.67756.19. Epub 2004 Mar 1.
BACKGROUND
We used intravascular ultrasound (IVUS) to evaluate recurrence after sirolimus-eluting stent (SES) implantation treatment of in-stent restenosis (ISR).
METHODS AND RESULTS
Forty-eight ISR lesions (41 patients with objective evidence of ischemia) were treated with SES. Recurrent ISR was identified in 11 lesions (all focal); repeat revascularization was performed in 10. These were compared with 16 patients (19 lesions) without recurrence as documented by angiography. Nine of 11 recurrent lesions had a minimum stent area (MSA) <5.0 mm2 versus 5 of 19 nonrecurrent lesions (P=0.003); 7 of 11 recurrent lesions had an MSA <4.0 mm2 versus 4 of 19 nonrecurrent lesions (P=0.02); and 4 of 11 recurrent lesions had an MSA <3.0 mm2 versus 1 of 19 nonrecurrent lesions (P=0.03). A gap between SESs was identified in 3 of 11 recurrences versus 1 of 19 nonrecurrent lesions.
CONCLUSIONS
Stent underexpansion is a significant cause of failure after SES implantation treatment of ISR.
背景
我们使用血管内超声（IVUS）评估西罗莫司洗脱支架（SES）植入治疗支架内再狭窄（ISR）后的复发情况。
方法与结果
48处ISR病变（41例有客观缺血证据的患者）接受了SES治疗。11处病变（均为局灶性）被确定为复发性ISR；10处进行了再次血运重建。将这些与16例（19处病变）经血管造影证实无复发的患者进行比较。11处复发性病变中有9处最小支架面积（MSA）<5.0 mm2，而19处非复发性病变中有5处（P = 0.003）；11处复发性病变中有7处MSA <4.0 mm2，而19处非复发性病变中有4处（P = 0.02）；11处复发性病变中有4处MSA <3.0 mm2，而19处非复发性病变中有1处（P = 0.03）。11处复发病变中有3处发现SES之间存在间隙，而19处非复发性病变中有1处。
结论
支架扩张不足是SES植入治疗ISR后失败的重要原因。
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