冠状动脉支架植入术前动脉重塑对支架内新生内膜增生及支架内再狭窄的影响。

Impact of preinterventional arterial remodeling on in-stent neointimal hyperplasia and in-stent restenosis after coronary stent implantation.

作者信息

Hong Young Joon, Jeong Myung Ho, Hyun Dae Woo, Hur Seung Ho, Kim Kwon Bae, Kim Weon, Lim Sang Yup, Lee Sang Hyun, Hong Seo Na, Kim Kye Hoon, Yun Kyung Ho, Kang Dong Goo, Lee Yun Sang, Park Hyung Wook, Kim Ju Han, Ahn Young Keun, Cho Jeong Gwan, Park Jong Chun, Kang Jung Chaee

机构信息

The Heart Center of Chonnam National University Hospital, Chonnam National University Research Institute of Medical Sciences, Gwangju, Korea.

出版信息

Circ J. 2005 Apr;69(4):414-9. doi: 10.1253/circj.69.414.

DOI:10.1253/circj.69.414

PMID:15791035

Abstract

BACKGROUND

Patterns of arterial remodeling during the course of plaque development have been shown to play an important role in both the progression of de novo atherosclerosis and in the restenotic process following coronary intervention. The aim of the present prospective study was to evaluate the effect of pre-interventional arterial remodeling on in-stent neointimal hyperplasia (NIH) and in-stent restenosis (ISR) after stenting.

METHODS AND RESULTS

Pre-interventional arterial remodeling was assessed in 85 native coronary lesions by using intravascular ultrasound (IVUS). The remodeling index (RI) was 1.09+/-0.20 in the positive remodeling (PR)/intermediate remodeling (IR) group and 0.84+/-0.12 in the negative remodeling (NR) group. The plaque plus media cross sectional area (P&M CSA) at pre-intervention and NIH CSA at follow-up in the minimal lumen CSA were significantly larger in the PR/IR group (9.2+/-2.9 mm2 vs 6.2+/-1.8 mm2, 3.3+/-1.2 mm2 vs 1.5+/-0.9 mm2; p = 0.001, p = 0.001, respectively). On 3-dimensional analysis of IVUS images at follow-up, the lumen volume was significantly smaller in the PR/IR group than that in the NR group (62+/-15 mm3 vs 75 +/-20 mm3; p = 0.001), and neointima hyperplasia volume was significantly larger in the PR/IR group than that in the NR group (46+/-15 mm3 vs 26+/-10 mm3; p = 0.001). A significant positive correlation was found between pre-interventional RI and follow-up NIH CSA (r = 0.25, p = 0.022). The incidence of ISR and repeat intervention was significantly higher in the PR/IR group (30.8% vs 18.2%, 28.8% vs 15.2%; p = 0.032, 0.035, respectively).

CONCLUSION

Measuring pre-interventional arterial remodeling patterns by IVUS may be helpful to stratify lesions at high-risk of ISR.

摘要

背景

斑块发展过程中的动脉重塑模式已被证明在初发动脉粥样硬化进展以及冠状动脉介入后的再狭窄过程中均发挥重要作用。本前瞻性研究的目的是评估介入前动脉重塑对支架置入后支架内新生内膜增生（NIH）和支架内再狭窄（ISR）的影响。

方法与结果

采用血管内超声（IVUS）对85处冠状动脉原位病变的介入前动脉重塑进行评估。阳性重塑（PR）/中间重塑（IR）组的重塑指数（RI）为1.09±0.20，阴性重塑（NR）组为0.84±0.12。PR/IR组介入前斑块加中膜横截面积（P&M CSA）和随访时最小管腔CSA处的NIH CSA显著更大（分别为9.2±2.9mm²对6.2±1.8mm²，3.3±1.2mm²对1.5±0.9mm²；p = 0.001，p = 0.001）。在随访时对IVUS图像进行三维分析，PR/IR组的管腔容积显著小于NR组（62±15mm³对75±20mm³；p = 0.001），且PR/IR组的新生内膜增生容积显著大于NR组（46±15mm³对26±10mm³；p = 0.001）。介入前RI与随访时NIH CSA之间存在显著正相关（r = 0.25，p = 0.022）。PR/IR组的ISR发生率和再次干预率显著更高（分别为30.8%对18.2%，28.8%对15.2%；p = 0.032，0.035）。