Ferrero Valeria, Ribichini Flavio, Heyndrickx Guy R, De Bruyne Bernard, Piessens Marleen, Carlier Stéphane, Büchi Martin, Matullo Giuseppe, Vassanelli Corrado, Wijns William
Catheterization Laboratory of the Università del Piemonte Orientale, Ospedale Maggiore della Carità, Novara, Italy.
Am J Cardiol. 2004 Nov 15;94(10):1237-42. doi: 10.1016/j.amjcard.2004.07.106.
This study tested the combination of vascular brachytherapy (VBT) and self-expanding Wallstent implantation in coronary lesions of patients at high risk for restenosis as assessed angiographically by quantitative coronary analysis and by 3-dimensional intravascular ultrasound analysis. Twenty-nine "de novo" lesions were managed with a self-expanding stent alone (n = 19) or with a self-expanding stent after beta-VBT (n = 10) in 27 patients who had been identified by high levels of plasma angiotensin-converting enzyme as being prone to myointimal growth after stent implantation. At 6 months, the increase in stent strut diameter was similar in the 2 groups by quantitative coronary analysis and 3-dimensional intravascular ultrasound (Delta mean stent strut diameter -0.33 +/- 0.3 vs -0.40 +/- 0.3 mm, p = 0.5; Delta stent area -11.8 +/- 6.1 vs -12.0 +/- 6.1 mm(2), p = 0.9; Delta stent volume -96.9 +/- 112 vs -83.5 +/- 73 mm(3), p = 0.7; for groups treated with VBT and self-expanding stents and only self-expanding stents, respectively). In-stent neointimal proliferation was decreased in the group treated with VBT and self-expanding stents (minimal luminal diameter 2.5 +/- 0.8 vs 1.88 +/- 0.8 mm, p = 0.04) by quantitative coronary analysis (minimal luminal area 6.7 +/- 2.5 vs 4.1 +/- 1.9 mm(2), p = 0.01), by intravascular ultrasound, and proliferation volume (84.6 +/- 66.4 vs 159.2 +/- 103.5 mm(3), p = 0.05) by 3-dimensional intravascular ultrasound. Positive vessel and luminal remodelings were observed in 50% of the group treated with VBT and self-expanding stents and in 11% of the group treated only with self-expanding stents (p = 0.02). The combined use of VBT and self-expanding stents is a novel approach that enlarges vascular lumen by preventing vessel constriction and neointimal proliferation. The feasibility and good results of this experimental approach suggest that the simultaneous use of these 2 technologies may be an interesting alternative for difficult vascular districts with high restenosis rates, such as peripheral circulation in the lower limbs.
本研究通过定量冠状动脉分析和三维血管内超声分析，对血管近距离放射治疗（VBT）与自膨式Wallstent支架植入术联合应用于血管造影评估为再狭窄高危患者的冠状动脉病变进行了测试。27例血浆血管紧张素转换酶水平较高、被认定支架植入后易发生肌内膜增生的患者，其29处“原发”病变采用单纯自膨式支架治疗（n = 19）或β-VBT后自膨式支架治疗（n = 10）。6个月时，通过定量冠状动脉分析和三维血管内超声检查，两组支架支柱直径的增加相似（平均支架支柱直径变化-0.33±0.3对-0.40±0.3mm，p = 0.5；支架面积变化-11.8±6.1对-12.0±6.1mm²，p = 0.9；支架体积变化-96.9±112对-83.5±73mm³，p = 0.7；分别为VBT与自膨式支架联合治疗组和单纯自膨式支架治疗组）。通过定量冠状动脉分析（最小管腔直径2.5±0.8对1.88±0.8mm，p = 0.04）、血管内超声检查（最小管腔面积6.7±2.5对4.1±1.9mm²，p = 0.01）以及三维血管内超声检查的增殖体积（84.6±66.4对159.2±103.5mm³，p = 0.05），VBT与自膨式支架联合治疗组的支架内新生内膜增殖减少。VBT与自膨式支架联合治疗组50%出现正向血管和管腔重塑，单纯自膨式支架治疗组为11%（p = 0.02）。VBT与自膨式支架联合应用是一种通过防止血管收缩和新生内膜增殖来扩大血管腔的新方法。这种实验方法的可行性和良好结果表明，同时使用这两种技术可能是下肢外周循环等高再狭窄率困难血管区域的一种有趣替代方案。
