Feres Fausto, Muñoz Juan S, Abizaid Alexandre, Albertal Mariano, Mintz Gary S, Staico Rodolfo, Centemero Marinella, Mattos Luiz A, Maldonado Galo, Tanajura Luiz F, Chaves Aurea, Pinto Ibraim, Abizaid Andrea S, Seixas Ana C, Vaz Vinicius Daher, Sousa Amanda, Sousa J Eduardo
Institute Dante Pazzanese of Cardiology, São Paulo, Brazil.
Am J Cardiol. 2005 Dec 15;96(12):1656-62. doi: 10.1016/j.amjcard.2005.07.081. Epub 2005 Oct 21.
We report the outcomes of patients who had in-stent restenosis (IRS) that was treated with intravascular brachytherapy (IVBT) or sirolimus-eluting stent (SES) implantation. The benefit of IVBT for treating ISR is well documented. SES implantation decreases first-time ISR and, in preliminary reports, has been used to treat ISR. Fifty consecutive patients who had ISR were treated; the first 25 patients underwent SES implantation and the next 25 patients were treated with IVBT using a beta-Cath System (a 40-mm strontium-90/yttrium-90 source). Quantitative angiographic and intravascular ultrasound follow-up were performed at 5.2 +/- 1.1 and 12.1 +/- 1.2 months; clinical follow-up was performed at 15 months. SES deployment and IVBT were successful in all patients. At 12-month follow-up, 8 patients who underwent IVBT had angiographic recurrence (4 in the stent and 4 at the stent edge); only 1 patient who underwent SES implantation developed recurrent ISR. At 12 months, in-stent late luminal loss was similar between the SES and IVBT groups (0.35 +/- 0.45 vs 0.34 +/- 0.46 mm, p = 0.9); however, in-stent net luminal gain was higher in the SES group than in the IVBT group (1.32 +/- 0.13 vs 0.57 +/- 0.19 mm, p <0.0001), and in-lesion late luminal loss was higher in the IVBT group (0.48 +/- 0.32 vs 0.16 +/- 0.42 mm, p = 0.004). At 12 months, intravascular ultrasound stent volume obstruction was higher after IVBT versus than after SES implantation (38.7% vs 6.7%, p <0.0001). At 15-month clinical follow-up, 64% and 96% (p <0.01) of patients who underwent IVBT and SES implantation, respectively, were free of major adverse cardiac events. In conclusion SES implantation for the treatment of ISR was effective and superior to catheter-based IVBT in preventing recurrent neointimal proliferation and angiographic restenosis at 1-year follow-up.
我们报告了接受血管内近距离放射治疗（IVBT）或西罗莫司洗脱支架（SES）植入治疗的支架内再狭窄（IRS）患者的治疗结果。IVBT治疗ISR的益处已有充分文献记载。SES植入可降低首次ISR发生率，并且在初步报告中已被用于治疗ISR。连续50例ISR患者接受了治疗；前25例患者接受了SES植入，后25例患者使用beta-Cath系统（一种40毫米锶-90/钇-90源）进行了IVBT治疗。在5.2±1.1个月和12.1±1.2个月时进行了定量血管造影和血管内超声随访；在15个月时进行了临床随访。所有患者的SES植入和IVBT治疗均成功。在12个月的随访中，接受IVBT治疗的8例患者出现了血管造影复发（4例在支架内，4例在支架边缘）；仅1例接受SES植入的患者发生了复发性ISR。在12个月时，SES组和IVBT组的支架内晚期管腔丢失相似（0.35±0.45对0.34±0.46毫米，p = 0.9）；然而，SES组的支架内净管腔增益高于IVBT组（1.32±0.13对0.57±0.19毫米，p<0.0001），并且IVBT组的病变内晚期管腔丢失更高（0.48±0.32对0.16±0.42毫米，p = 0.004）。在12个月时，IVBT后的血管内超声支架体积阻塞高于SES植入后（38.7%对6.7%，p<0.0001）。在15个月的临床随访中，接受IVBT和SES植入的患者分别有64%和96%（p<0.01）无主要不良心脏事件。总之，在1年随访中，SES植入治疗ISR在预防复发性新生内膜增生和血管造影再狭窄方面有效且优于基于导管的IVBT。
