Rau M, Maikowski C, Weber M, Keil E, Elsässer A, Möllmann H, Hamm C
Department of Cardiology, Kerckhoff-Klinik, Benekestr. 2-8, 61231 Bad Nauheim, Germany.
Z Kardiol. 2005 Nov;94(11):742-7. doi: 10.1007/s00392-005-0298-y.
Treatment of in-stent restenosis (ISR) remains a therapeutic challenge since many pharmacological and mechanical approaches have shown disappointing results except for brachytherapy. Drug-eluting stents (DES) have been reported to effectively reduce ISR in de novo lesions. We studied 55 consecutive patients with ISR in native coronary arteries and 7 with ISR in saphenous vein grafts (SVG) with elective indication for percutaneous coronary intervention (PCI), who underwent successful implantation with DES. No in-hospital postprocedural major adverse cardiac events were observed. All but one patient (n=61) underwent an angiographic follow-up at 183+/-30 days. Grade of stenosis was assessed by quantitative coronary angiography (QCA) at index procedure and at control angiography. Restenosis (>50%) occurred in 5 patients (8.2%). Target vessel revascularization was performed in an additional 4 patients. Minimal intimal hyperplasia was observed in all segments covered by DES (late loss 0.08+/-0.37 mm, loss index 0.11+/-0.47). One patient suffered from subacute stent thrombosis due to discontinuation of clopidogrel medication. At six month follow-up two patients had died. Death was not related to a restenosis in the treated segment. Conclusion Our experiences with DES treatment of ISR lesions show good angiographic and clinical results at index procedure and at the 6 month follow-up with low sub acute thrombosis rate as compared with existing treatment modalities. Restenosis rate seems to be at least as low as reported for brachytherapy.
支架内再狭窄（ISR）的治疗仍然是一项治疗挑战，因为除了近距离放射治疗外，许多药物和机械方法的效果都不尽人意。据报道，药物洗脱支架（DES）可有效减少原发性病变中的ISR。我们研究了55例连续性原发性冠状动脉ISR患者和7例大隐静脉桥血管（SVG）ISR患者，这些患者均有经皮冠状动脉介入治疗（PCI）的择期指征，并成功植入了DES。未观察到院内术后主要不良心脏事件。除1例患者外（n = 61），所有患者均在183±30天进行了血管造影随访。在初次手术和对照血管造影时通过定量冠状动脉造影（QCA）评估狭窄程度。5例患者（8.2%）发生再狭窄（>50%）。另外4例患者进行了靶血管血运重建。在DES覆盖的所有节段均观察到最小内膜增生（晚期管腔丢失0.08±0.37 mm，丢失指数0.11±0.47）。1例患者因停用氯吡格雷药物发生亚急性支架血栓形成。在6个月随访时，2例患者死亡。死亡与治疗节段的再狭窄无关。结论 我们使用DES治疗ISR病变的经验显示，在初次手术时和6个月随访时，血管造影和临床结果良好，与现有治疗方式相比，亚急性血栓形成率较低。再狭窄率似乎至少与近距离放射治疗报道的一样低。
