Costa Marco A, Sabate Manel, Angiolillo Dominick J, Jimenez-Quevedo Pilar, Teirstein Paul, Carter Andrew, Leon Martin B, Moses Jeffrey, Zenni Martin, Yakubov Steven, Guzman Luis A, Gilmore Paul, Macaya Carlos, Bass Theodore A
Division of Cardiology, University of Florida, Shands-Jacksonville, Florida, USA.
Am J Cardiol. 2006 Jan 15;97(2):203-6. doi: 10.1016/j.amjcard.2005.07.136. Epub 2005 Nov 28.
An intraluminal echolucent tissue, dubbed "black hole," has been identified by intravascular ultrasonography after intracoronary brachytherapy. This study reports the characteristics and incidence of the black hole in patients treated with drug-eluting stent implantation using a sirolimus-eluting stent (SES). We included intravascular ultrasound data from the Compassionate Use of Sirolimus-Eluting Stent (SECURE, n = 61 lesions) registry, a study involving patients in whom previous brachytherapy had failed, and the DIABETES trial (n = 165 lesions), a multicenter, randomized study comparing SES versus bare metal stents in diabetic patients. Intravascular ultrasound follow-up was scheduled at 8 months (SECURE trial, post-brachytherapy population) and 9 months (DIABETES trial). In the SECURE population, a black hole was observed in 10 patients (19.6%). Seven black hole segments had significant intimal hyperplasia (> 10%). A black hole accounted for 27% of total intraluminal tissue. In the DIABETES trial, 2 patients (2.5%) in the SES group and none in the bare metal stent group showed echolucent intimal hyperplasia. In conclusion, a black hole occurred frequently after implantation of a SES in patients in whom intracoronary brachytherapy had previously failed. Black holes were also identified in a nonirradiated population, although the incidence was lower than in the post-brachytherapy patients. Bare metal stents were not associated with this phenomenon.
冠状动脉近距离放射治疗后，血管内超声检查发现了一种腔内透声组织，称为“黑洞”。本研究报告了使用西罗莫司洗脱支架（SES）进行药物洗脱支架植入的患者中“黑洞”的特征和发生率。我们纳入了来自西罗莫司洗脱支架同情使用（SECURE，n = 61个病变）注册研究的血管内超声数据，该研究涉及先前近距离放射治疗失败的患者，以及糖尿病试验（n = 165个病变），这是一项比较SES与裸金属支架在糖尿病患者中的多中心随机研究。血管内超声随访计划在8个月（SECURE试验，近距离放射治疗后人群）和9个月（糖尿病试验）进行。在SECURE人群中，10名患者（19.6%）观察到“黑洞”。7个“黑洞”节段有明显的内膜增生（> 10%）。“黑洞”占腔内组织总量的27%。在糖尿病试验中，SES组有2名患者（2.5%）出现透声性内膜增生，裸金属支架组无此情况。总之，在先前冠状动脉近距离放射治疗失败的患者中植入SES后，“黑洞”频繁出现。在未接受照射的人群中也发现了“黑洞”，尽管其发生率低于近距离放射治疗后的患者。裸金属支架与这种现象无关。
