药物洗脱支架与β射线治疗弥漫性支架内再狭窄的比较：临床及血管造影结果

Comparison between drug-eluting stents and beta-radiation for the treatment of diffuse in-stent restenosis: clinical and angiographic outcomes.

作者信息

Zavalloni Dennis, Belli Guido, Rossi Marco L, Scatturin Melania, Morenghi Emanuela, Catalano Gianpiero, Tosi Giovanni, Gasparini Gabriele L, Pagnotta Paolo, Presbitero Patrizia

机构信息

U.O. Emodinamica e Cardiologia Invasiva, Istituto Clinico Humanitas, Milan, Italy.

出版信息

Am Heart J. 2006 Nov;152(5):908.e1-7. doi: 10.1016/j.ahj.2006.01.014.

DOI:10.1016/j.ahj.2006.01.014

PMID:17070155

Abstract

BACKGROUND

Initial reports on drug-eluting stents (DES) for the treatment for in-stent restenosis (ISR) show very good outcomes. Nevertheless, few data are available on direct comparison with intracoronary brachytherapy (IBT). The aim of this study was to compare brachytherapy and DES in treatment of diffuse ISR.

METHODS

One hundred forty-one consecutive patients with diffuse ISR were treated with IBT (68 patients; beta (90Sr/90Y) emitters) or with DES (73 patients; 32 with sirolimus-eluting and 41 with paclitaxel-eluting stents). Angiographic and clinical follow-up was scheduled within 9 months.

RESULTS

The first 74 lesions were treated with IBT (group 1) and the latter 74 with DES (group 2). The two groups were well matched for clinical/angiographic characteristics. At follow-up, restenosis rates were 37.8% (28/74) in IBT group and 14.9% (11/74) in DES group (P = .0028). A diffuse pattern of recurrence was more frequent after IBT (20/74 vs 6/74, P = .005). A worse outcome after IBT was associated with the "edge effect," accounting for most failures. Recurrence within the original restenotic stent was similar in both groups (12.9% vs 14.9% in groups 1 and 2 respectively, P = .8).

CONCLUSIONS

Drug-eluting stents are more effective than IBT with beta-irradiation in reducing recurrence rates after treatment of diffuse ISR. In case of failure, the pattern of restenosis is more benign after treatment with DES.

摘要

背景

关于药物洗脱支架（DES）治疗支架内再狭窄（ISR）的初步报告显示出非常好的效果。然而，与冠状动脉内近距离放射治疗（IBT）直接比较的数据却很少。本研究的目的是比较近距离放射治疗和DES治疗弥漫性ISR的效果。

方法

141例连续的弥漫性ISR患者接受了IBT治疗（68例患者；使用β（90Sr/90Y）发射源）或DES治疗（73例患者；32例使用西罗莫司洗脱支架，41例使用紫杉醇洗脱支架）。计划在9个月内进行血管造影和临床随访。

结果

前74个病变采用IBT治疗（第1组），后74个病变采用DES治疗（第2组）。两组在临床/血管造影特征方面匹配良好。随访时，IBT组的再狭窄率为37.8%（28/74），DES组为14.9%（11/74）（P = 0.0028）。IBT后弥漫性复发模式更常见（20/74对6/74，P = 0.005）。IBT后较差的结果与“边缘效应”有关，这是大多数失败的原因。两组在原再狭窄支架内的复发情况相似（第1组和第2组分别为12.9%对14.9%，P = 0.8）。