Seo Atsushi, Fujii Takuro, Inoue Terumasa, Onoda Satoru, Koga Atsushi, Tanaka Yasuyuki, Chin Keiichi, Kurusu Takashi, Takikawa Kazutoshi, Shibata Takahiro, Taniguchi Masayuki, Mochizuki Seibu
Division of Cardiology, Department of Internal Medicine, The Jikei University School of Medicine, Daisan Hospital, Komae-shi, Tokyo, Japan.
Int Heart J. 2007 Mar;48(2):137-47. doi: 10.1536/ihj.48.137.
The aim of this study was to compare the initial and long-term outcomes of sirolimus-eluting stents (SES) and bare-metal stents (BMS) in patients with calcified lesions without performing rotational atherectomy. The subjects were 79 consecutive lesions (38 in the SES group and 41 in the BMS group) which were confirmed to have superficially calcified lesions by intravascular ultrasound. In all lesions, the stent was implanted after predilatation with a balloon. The patient characteristics were not different between the 2 groups. All procedures were successfully performed in both groups. Vessel area was significantly smaller in the SES group than in the BMS group (11.01 +/- 3.88 mm(2) versus 13.08 +/- 3.49 mm(2), P < 0.005), as was the lumen area (5.41 +/- 2.31mm(2) versus 6.48 +/- 2.04 mm(2), P < 0.005). Minimum stent area was significantly smaller in the SES group than in the BMS group (5.61 +/- 1.54 mm(2) versus 6.69 +/- 1.74 mm(2), P < 0.01). In cases in whom angiographic follow-ups were performed, the late loss was significantly smaller in the SES group than in the BMS group (0.19 +/- 0.49 mm versus 0.76 +/- 0.48 mm, P < 0.001). The restenosis rate was significantly lower in the SES group than in the BMS group (8.8% versus 33.3%, P < 0.05) and the TLR rate tended to be lower in the SES group (7.9% versus 19.5%). Stent thrombosis was not observed in either group. The results suggest that SES are more effective than BMS and can be used safely when treating calcified lesions if predilatation with a balloon is possible.
本研究的目的是比较在不进行旋磨术的情况下，西罗莫司洗脱支架（SES）和裸金属支架（BMS）在钙化病变患者中的初始和长期疗效。研究对象为79个连续病变（SES组38个，BMS组41个），经血管内超声证实为浅表钙化病变。在所有病变中，支架均在球囊预扩张后植入。两组患者的特征无差异。两组所有手术均成功完成。SES组的血管面积显著小于BMS组（11.01±3.88mm²对13.08±3.49mm²，P<0.005），管腔面积也是如此（5.41±2.31mm²对6.48±2.04mm²，P<0.005）。SES组的最小支架面积显著小于BMS组（5.61±1.54mm²对6.69±1.74mm²，P<0.01）。在进行血管造影随访的病例中，SES组的晚期管腔丢失显著小于BMS组（0.19±0.49mm对0.76±0.48mm，P<0.001）。SES组的再狭窄率显著低于BMS组（8.8%对33.3%，P<0.05），SES组的靶病变血运重建率也有降低趋势（7.9%对19.5%）。两组均未观察到支架血栓形成。结果表明，SES比BMS更有效，并且如果可以进行球囊预扩张，在治疗钙化病变时可以安全使用。
