Agostoni Pierfrancesco, Vermeersch Paul, Semeraro Oscar, Verheye Stefan, Van Langenhove Glenn, Van den Heuvel Paul, Convens Carl, Van den Branden Frank, Bruining Nico
Antwerp Cardiovascular Institute Middelheim, AZ Middelheim, Antwerp, Belgium.
Am J Cardiol. 2007 Jul 1;100(1):52-8. doi: 10.1016/j.amjcard.2007.02.052. Epub 2007 May 11.
The randomized Reduction of Restenosis In Saphenous Vein Grafts with Cypher Sirolimus-Eluting Stent trial compared angiographic outcomes of sirolimus-eluting stents (SESs) versus bare metal stents (BMSs) in saphenous vein grafts (SVG). Using intravascular ultrasound (IVUS) performed during 6-month follow-up angiography, we compared the vascular effects of the 2 types of stent on SVGs. Of 75 patients (96 lesions) included, 59 patients underwent IVUS in 61 SVGs; 29 patients received 40 SESs for 34 lesions, and 30 patients received 42 BMSs for 39 lesions. IVUS parameters (diameters, areas, and volumes) were compared in the 2 groups. A specific analysis was performed for overlapping SESs. Median neointimal volume was 1.3 mm(3) (interquartile range 0 to 13.1) in SESs versus 24.5 (7.8 to 39.5) in BMSs (p <0.001). Minimal incomplete stent apposition was detected at only 3 stent edges (2 BMSs, 1 SES) next to ectatic regions of the SVG. Compared with single SESs, overlapping SESs showed significant increases in neointimal reaction, with a neointimal volume of 0.6 mm(3)/mm of stent (0.1 to 1.8) versus 0 (0 to 0.4) in single SESs (p = 0.03), and this phenomenon was mainly localized in overlapping SES segments, where neointimal volume per millimeter of stent was 1.1 mm(3)/mm (0.6 to 4.4) versus 0 (0 to 1.3) in nonoverlapping segments (p = 0.05). In conclusion, SESs effectively inhibit neointimal hyperplasia volume compared with BMSs in diseased vein grafts, without evidence of increased incomplete apposition risk. The neointimal response to overlapping SES layers seems higher than to a single SES layer.
西罗莫司洗脱支架降低大隐静脉移植血管再狭窄的随机试验比较了西罗莫司洗脱支架（SES）与裸金属支架（BMS）在大隐静脉移植血管（SVG）中的血管造影结果。利用6个月随访血管造影期间进行的血管内超声（IVUS），我们比较了这两种类型支架对SVG的血管效应。纳入的75例患者（96处病变）中，59例患者在61处SVG中接受了IVUS检查；29例患者为34处病变植入40枚SES，30例患者为39处病变植入42枚BMS。比较两组的IVUS参数（直径、面积和体积）。对重叠的SES进行了专项分析。SES的新生内膜体积中位数为1.3mm³（四分位间距0至13.1），而BMS为24.5（7.8至39.5）（p<0.001）。仅在SVG扩张区域旁的3个支架边缘（2个BMS，1个SES）检测到最小不完全支架贴壁。与单个SES相比，重叠SES的新生内膜反应显著增加，新生内膜体积为0.6mm³/mm支架（0.1至1.8），而单个SES为0（0至0.4）（p=0.03），这种现象主要局限于重叠SES节段，该节段每毫米支架的新生内膜体积为1.1mm³/mm（0.6至4.4），而非重叠节段为0（0至1.3）（p=0.05）。总之，在病变静脉移植血管中，与BMS相比，SES能有效抑制新生内膜增生体积，且无不完全贴壁风险增加的证据。新生内膜对重叠SES层的反应似乎高于单个SES层。
