Awata Masaki, Kotani Jun-ichi, Uematsu Masaaki, Morozumi Takakazu, Watanabe Tetsuya, Onishi Toshinari, Iida Osamu, Sera Fusako, Nanto Shinsuke, Hori Masatsugu, Nagata Seiki
Cardiovascular Division, Kansai Rosai Hospital, Amagasaki, Japan.
Circulation. 2007 Aug 21;116(8):910-6. doi: 10.1161/CIRCULATIONAHA.105.609057. Epub 2007 Aug 7.
The time course of neointimal formation after stent implantation has not been studied extensively by angioscopy in the drug-eluting stent era.
Serial angioscopic findings at first follow-up (3.6+/-1.1 months), second follow-up (10.5+/-1.6 months), and third follow-up (21.2+/-2.2 months) after stent implantation were compared between sirolimus-eluting stents (SES, n=17) and bare-metal stents (BMS, n=11). Neointimal coverage, thrombus, and presence of yellow plaques underneath the stents were assessed. Neointimal coverage was graded as follows: grade 0, stent struts were fully visible; grade 1, struts bulged into the lumen, although they were covered; grade 2, struts were embedded by the neointima but were seen translucently; or grade 3, struts were fully embedded and invisible. Neointimal coverage was remarkably different between SES and BMS at each follow-up point. Neointimal coverage grade was 1.1+/-0.5 in SES versus 2.9+/-0.3 in BMS at the first follow-up (P<0.0001), 1.1+/-0.5 in SES versus 3.0+/-0.0 in BMS (P<0.0001) at the second follow-up, and 1.3+/-0.5 in SES versus 3.0+/-0.0 in BMS at the third follow-up (P=0.0009). No significant serial changes in coverage grade were noted in the BMS group, whereas coverage grade slightly but significantly increased at the third follow-up in the SES group (P<0.05). Thrombi were detected in 4 SES: a red thrombus was seen from the first to the third follow-up in 2; another was detected only at the third follow-up; and the fourth was seen at the first follow-up but disappeared at the second follow-up, associated with a new white thrombus despite dual antiplatelet therapy. Yellow plaques had disappeared by the time of the second follow-up in BMS. In contrast, yellow plaques were exposed in 71% of SES at the first follow-up and remained exposed until the third follow-up. Neointimal coverage grades correlated with thrombi (P=0.002) and with yellow plaques (P<0.0001).
Serial angioscopic findings up to 2 years after SES implantation were markedly different from those after BMS. Neointimal coverage was completed by 3 to 6 months in BMS. In contrast, SES demonstrated the presence of thrombi and yellow plaques even as much as 2 years after implantation.
在药物洗脱支架时代，血管内镜尚未广泛研究支架植入后新生内膜形成的时间进程。
比较了西罗莫司洗脱支架（SES，n = 17）和裸金属支架（BMS，n = 11）植入后首次随访（3.6±1.1个月）、第二次随访（10.5±1.6个月）和第三次随访（21.2±2.2个月）时的系列血管内镜检查结果。评估了新生内膜覆盖情况、血栓以及支架下方黄色斑块的存在情况。新生内膜覆盖情况分级如下：0级，支架小梁完全可见；1级，小梁向管腔内突出，尽管被覆盖；2级，小梁被新生内膜包埋但仍可半透明地看到；3级，小梁完全被包埋且不可见。在每个随访点，SES和BMS的新生内膜覆盖情况有显著差异。首次随访时，SES的新生内膜覆盖分级为1.1±0.5，而BMS为2.9±0.3（P<0.0001）；第二次随访时，SES为1.1±0.5，BMS为3.0±0.0（P<0.0001）；第三次随访时，SES为1.3±0.5，BMS为3.0±0.0（P = 0.0009）。BMS组的覆盖分级无显著的系列变化，而SES组在第三次随访时覆盖分级略有但显著增加（P<0.05）。在4个SES中检测到血栓：2个从首次随访至第三次随访可见红色血栓；另一个仅在第三次随访时检测到；第四个在首次随访时可见但在第二次随访时消失，尽管进行了双联抗血小板治疗，但出现了新白色血栓。BMS中黄色斑块在第二次随访时已消失。相比之下，SES在首次随访时有71%的黄色斑块暴露，直至第三次随访时仍保持暴露。新生内膜覆盖分级与血栓（P = 0.002）和黄色斑块（P<0.0001）相关。
SES植入后长达2年的系列血管内镜检查结果与BMS明显不同。BMS在3至6个月时完成新生内膜覆盖。相比之下，SES即使在植入后2年仍有血栓和黄色斑块存在。
