Zavalloni Dennis, Rossi Marco, Belli Guido, Scatturin Melania, Morenghi Emanuela, Marsico Federica, Catalano Giampiero, Tosi Giovanni, Pagnotta Paolo, Presbitero Patrizia
Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milan, Italy.
J Invasive Cardiol. 2005 Nov;17(11):598-602.
Brachytherapy (IBT) has been the first effective treatment of in-stent restenosis (ISR). However, when IBT is associated with additional stenting, high rates of late thrombosis have been observed. Even though prolongation of a double antiplatelet therapy seems to have overcome this problem, studies analyzing whether additional stenting still remains a negative prognostic factor for restenosis are lacking.
To evaluate outcomes of patients treated for ISR with or without additional stenting and IBT followed by prolonged antiplatelet therapy.
Seventy-seven consecutive patients treated with beta radiation in 89 lesions with ISR were analyzed according to the need for deploying additional stents: 73 lesions were treated without additional stents (Group 1) and 16 lesions with one or more new stents (Group 2) because of suboptimal results or flow-limiting dissections. Double antiplatelet therapy was administered for 12 months. An angiographic follow-up was scheduled after 6 months. P-values < 0.05 were considered significant.
Restenosis rates were 31.5% (23/73) and 62.5% (10/16) in Group 1 (G1) and Group 2 (G2), respectively (p = 0.02). The two groups did not differ for late vessel thrombosis (8 in G1 and 2 in G2). In G2, high rates of recurrence were observed in the additional stent (6/16, 37.5%; p = 0.02 versus edge restenosis and in old stent recurrence in both G1 and G2).
The association of additional stenting with brachytherapy in treatment of ISR is characterized by poor outcomes, even if a prolonged antiplatelet therapy has been administered. These results are related to high restenosis rates observed in the additional stent.
近距离放射治疗（IBT）一直是治疗支架内再狭窄（ISR）的首个有效方法。然而，当IBT与额外的支架置入相关联时，已观察到较高的晚期血栓形成率。尽管延长双联抗血小板治疗似乎已克服了这一问题，但缺乏分析额外的支架置入是否仍然是再狭窄的不良预后因素的研究。
评估接受或未接受额外支架置入及IBT并随后接受延长抗血小板治疗的ISR患者的结局。
根据是否需要置入额外支架，对89处ISR病变接受β射线放射治疗的77例连续患者进行分析：73处病变未置入额外支架（第1组），16处病变因效果欠佳或限流性夹层而置入一个或多个新支架（第2组）。双联抗血小板治疗持续12个月。计划在6个月后进行血管造影随访。P值<0.05被认为具有统计学意义。
第1组（G1）和第2组（G2）的再狭窄率分别为31.5%（23/73）和62.5%（10/16）（p = 0.02）。两组在晚期血管血栓形成方面无差异（G1组8例，G2组2例）。在G2组中，额外支架内观察到较高的复发率（6/16，37.5%；与边缘再狭窄相比p = 0.02，且G1组和G2组的旧支架内均有复发）。
即使给予了延长的抗血小板治疗，在ISR治疗中额外的支架置入与近距离放射治疗联合应用的结局仍较差。这些结果与额外支架内观察到的高再狭窄率有关。
