Takebayashi Hideo, Mintz Gary S, Carlier Stéphane G, Kobayashi Yoshio, Fujii Kenichi, Yasuda Takenori, Costa Ricardo A, Moussa Issam, Dangas George D, Mehran Roxana, Lansky Alexandra J, Kreps Edward, Collins Michael B, Colombo Antonio, Stone Gregg W, Leon Martin B, Moses Jeffrey W
Cardiovascular Research Foundation, Lenox Hill Heart and Vascular Institute, New York, NY 10022, USA.
Circulation. 2004 Nov 30;110(22):3430-4. doi: 10.1161/01.CIR.0000148371.53174.05. Epub 2004 Nov 22.
Little is known about causes of intimal hyperplasia (IH) after sirolimus-eluting stent (SES) implantation.
Intravascular ultrasound was performed in 24 lesions with intra-SES restenosis and a comparison group of 25 nonrestenotic SESs. To assess stent strut distribution, the maximum interstrut angle was measured with a protractor centered on the stent, and the visible struts were counted and normalized for the number of stent cells. In SES restenosis patients, minimum lumen site was compared with image slices 2.5, 5.0, 7.5, and 10.0 mm proximal and distal to this site. The minimum lumen site had a smaller IVUS lumen area at follow-up (2.7+/-0.9 versus 6.2+/-1.9 mm2; P<0.01), larger maximum interstrut angle (135+/-39 degrees versus 72+/-23 degrees; P<0.01), larger IH area (3.4+/-1.5 versus 0.6+/-1.1 mm2; P<0.01) and thickness (0.7+/-0.3 versus 0.1+/-0.2 mm; P<0.01) at maximum interstrut angle, and fewer stent struts (4.9+/-1.0 versus 6.0+/-0.5; P<0.01) even when normalized for the number of stent cells (0.78+/-0.15 versus 0.97+/-0.07; P<0.01). Compared with nonrestenotic SES, the restenosis lesions also had a smaller minimal lumen area, larger IH area, thicker IH at maximum interstrut angle, fewer stent struts, and larger maximum interstrut angle. Multivariate analysis identified the number of visualized stent struts normalized for the number of stent cells and maximum interstrut angle as the only independent IVUS predictor of IH cross-sectional area (P<0.01 and P<0.01), minimum lumen area (P<0.01 and P<0.01), and IH thickness (P<0.01 and P<0.01).
The number and distribution of stent struts affect the amount of neointima after SES implantation.
关于西罗莫司洗脱支架（SES）植入后内膜增生（IH）的原因知之甚少。
对24处SES内再狭窄病变以及25处无再狭窄的SES病变作为对照组进行血管内超声检查。为评估支架支柱分布，以支架为中心用分度器测量最大支柱间角度，并对可见支柱进行计数并根据支架网格数量进行标准化。在SES再狭窄患者中，将最小管腔部位与其近端和远端2.5、5.0、7.5及10.0 mm处的图像切片进行比较。随访时最小管腔部位的血管内超声管腔面积较小（2.7±0.9对6.2±1.9 mm²；P<0.01），最大支柱间角度较大（135±39度对72±23度；P<0.01），最大支柱间角度处的内膜增生面积较大（3.4±1.5对0.6±1.1 mm²；P<0.01）和厚度较大（0.7±0.3对0.1±0.2 mm；P<0.01），且支架支柱较少（4.9±1.0对6.0±0.5；P<0.01），即使根据支架网格数量进行标准化后也是如此（0.78±0.15对0.97±0.07；P<0.01）。与无再狭窄的SES相比，再狭窄病变的最小管腔面积也较小，内膜增生面积较大，最大支柱间角度处的内膜增生较厚，支架支柱较少，最大支柱间角度较大。多变量分析确定，根据支架网格数量标准化后的可见支架支柱数量和最大支柱间角度是内膜增生横截面积（P<0.01和P<0.01）、最小管腔面积（P<0.01和P<0.01）以及内膜增生厚度（P<0.01和P<0.01）的唯一独立血管内超声预测指标。
支架支柱的数量和分布影响SES植入后的新生内膜量。
