Takano Masamichi, Ohba Takayoshi, Inami Shigenobu, Seimiya Koji, Sakai Shunta, Mizuno Kyoichi
Department of Internal Medicine, Chiba-Hokusoh Hospital, Nippon Medical School 1715 Kamakari, Imba, Chiba 270-1694, Japan.
Eur Heart J. 2006 Sep;27(18):2189-95. doi: 10.1093/eurheartj/ehl181. Epub 2006 Aug 7.
The neointimal coverage and intracoronary thrombi within stented segments at 6 months after implantation between sirolimus-eluting stents (SESs) and bare metal stents (BMSs) were compared by direct visualization using angioscopy.
Forty-six patients (36 stable angina and 10 acute coronary syndrome) were treated with 33 SESs and 33 BMSs. Immediately after and 6 months after stenting, each of the stented segments, edge body, and overlapping segment were observed by angioscopy and the grade of neointimal coverage over the stents was classified as 0: absent neointima, 1: visible struts through thin neointima, or 2: invisible struts. The existence of thrombi was also evaluated. The average grade of the neointimal coverage at 6 months follow-up was lower in the SES than that in the BMS (edge: 1.4+/-0.7 vs. 1.9+/-0.2, body: 1.0+/-0.5 vs. 1.8+/-0.5, overlapping segment: 0.6+/-0.7 vs. 1.8+/-0.5; P<0.0001, P<0.0001, P=0.0069, respectively). The frequency of persistence of thrombus was significantly higher in the SESs than that in the BMSs (86 vs. 29%, respectively; P=0.031).
The present study suggested a delayed neointimal stent coverage and slower thrombus disappearance process in the SESs in comparison to the BMSs.
通过血管内镜直接观察比较西罗莫司洗脱支架（SES）和裸金属支架（BMS）植入后6个月时支架段内的新生内膜覆盖情况和冠状动脉内血栓形成情况。
46例患者（36例稳定型心绞痛和10例急性冠状动脉综合征）分别接受了33枚SES和33枚BMS治疗。在支架植入后即刻以及植入后6个月，通过血管内镜观察每个支架段、边缘体和重叠段，并将支架上新生内膜覆盖程度分为0级：无新生内膜；1级：透过薄新生内膜可见支架小梁；或2级：不可见支架小梁。同时评估血栓的存在情况。随访6个月时，SES组新生内膜覆盖的平均分级低于BMS组（边缘：1.4±0.7对1.9±0.2，体部：1.0±0.5对1.8±0.5，重叠段：0.6±0.7对1.8±0.5；P均<0.0001，P均<0.0001，P = 0.0069）。SES组血栓持续存在的频率显著高于BMS组（分别为86%对29%；P = 0.031）。
本研究提示，与BMS相比，SES存在新生内膜支架覆盖延迟和血栓消失过程缓慢的情况。
