de Ribamar Costa Jose, Mintz Gary S, Carlier Stéphane G, Fujii Kenichi, Sano Koichi, Kimura Masashi, Tanaka Kaoru, Costa Ricardo A, Lui Joanna, Na Yingbo, Castellanos Celia, Biro Sinan, Moussa Issam, Stone Gregg W, Moses Jeffrey W, Leon Martin B
Cardiovascular Research Foundation and Columbia University Medical Center, New York, NY, USA.
Am Heart J. 2007 Feb;153(2):297-303. doi: 10.1016/j.ahj.2006.08.026.
In the drug-eluting stent (DES) era, stent expansion remains an important predictor of restenosis and subacute thrombosis. Compliance charts are developed to predict final minimum stent diameter (MSD) and area (MSA). The objectives of the study were (1) to assess DES expansion by comparing intravascular ultrasound (IVUS)-measured MSD and MSA against the values predicted by compliance charts and (2) to compare each DES against its bare-metal stent (BMS) equivalent.
We enrolled 200 patients with de novo coronary lesions treated with single, >2.5-mm Cypher (Cordis, Johnson & Johnson, Miami Lakes, FL) (sirolimus-eluting stent [SES], 133 patients) or Taxus (Boston Scientific, Natick, MA) (paclitaxel-eluting stent [PES], 67 patients) stent under IVUS guidance without another postdilation balloon. We used a comparison cohort of 65 equivalent BMS (Express 2 [Boston Scientific], 37 patients; Bx Velocity [Cordis, Johnson & Johnson], 28 patients) deployed under similar conditions.
The DES achieved only 75% +/- 10% of predicted MSD and 66% +/- 17% of predicted MSA; this was similar for SES and PES. Furthermore, 24% of SES and 28% of PES did not achieve a final MSA of 5 mm(2), a consistent predictor of DES failure. The SES achieved 75% +/- 10% of predicted MSA versus 75% +/- 9% for Bx Velocity (P = .9). The PES achieved 79.9% +/- 14% of predicted MSA versus 79% +/- 10% for Express 2 (P = .8). Lesion morphology, arc and length of calcium, stent diameter and length, and implantation pressures did not affect expansion.
Compliance charts fail to predict final MSD and MSA. A considerable percentage of DES does not achieve minimum standards of stent expansion. The SES and PES achieve similar expansion to their BMS platform, indicating that the polymer coating does not affect DES expansion in vivo. However, stent expansion cannot be predicted from preintervention IVUS lesion assessment.
在药物洗脱支架（DES）时代，支架扩张仍然是再狭窄和亚急性血栓形成的重要预测指标。已制定顺应性图表来预测最终最小支架直径（MSD）和面积（MSA）。本研究的目的是：（1）通过将血管内超声（IVUS）测量的MSD和MSA与顺应性图表预测的值进行比较来评估DES的扩张情况；（2）将每种DES与其裸金属支架（BMS）等效物进行比较。
我们纳入了200例新发冠状动脉病变患者，在IVUS引导下使用单个直径大于2.5 mm的Cypher（Cordis公司，强生公司，迈阿密湖，佛罗里达州）（西罗莫司洗脱支架[SES]，133例患者）或Taxus（波士顿科学公司，纳蒂克，马萨诸塞州）（紫杉醇洗脱支架[PES]，67例患者）支架，且未使用另一个后扩张球囊。我们使用了一个65个等效BMS（Express 2[波士顿科学公司]，37例患者；Bx Velocity[Cordis公司，强生公司]，28例患者）的比较队列，这些BMS在相似条件下植入。
DES仅达到预测MSD的75%±10%和预测MSA的66%±17%；SES和PES的情况相似。此外，24%的SES和28%的PES未达到5 mm²的最终MSA，这是DES失败的一个一致预测指标。SES达到预测MSA的75%±10%，而Bx Velocity为75%±9%（P = 0.9）。PES达到预测MSA的79.9%±14%，而Express 2为79%±10%（P = 0.8）。病变形态、钙化弧和长度、支架直径和长度以及植入压力均不影响扩张。
顺应性图表无法预测最终的MSD和MSA。相当比例的DES未达到支架扩张的最低标准。SES和PES与其BMS平台的扩张情况相似，表明聚合物涂层在体内不影响DES的扩张。然而，无法从干预前的IVUS病变评估预测支架扩张情况。
