Kim Sang-Wook, Mintz Gary S, Lee Kwang-Je, Pregowski Jerzy, Tyczynski Pawel, Escolar Esteban, Michalek Aleksandra, Lu Li, Pichard Augusto D, Satler Lowell F, Suddath William O, Waksman Ron, Weissman Neil J
Washington Hospital Center, 100 Irving Street, N.W., Suite EB 5123, Washington, D.C., 20010, USA.
J Invasive Cardiol. 2007 Dec;19(12):506-9.
Stents are used to treat the first and even successive episodes of in-stent restenosis (ISR).
In 18 patients (19 lesions), intravascular ultrasound (IVUS) was performed after placement of a stent for a nonrestenotic lesion after the second stent was used to treat the first episode of ISR and after the third stent was used to treat the second episode of ISR. The duration between the first and second stent was 355 +/- 374 days, and between the second and third stent was 330 +/- 279 days. The duration of follow up after the third stent was 307 +/- 145 days. High-pressure inflation (> 14 atm) was performed for 69% (11/16) of patients when treating the first episode of ISR, and all patients when treating the re-ISR (p = 0.018).
Nevertheless, vessel area and final minimal stent area (MSA) did not increase with successive restenting, and the ratio of minimum stent diameter to nominal stent size suggested that chronic stent underexpansion persisted. MSA > 5 mm2 was noted in 54% after the first stent, 35% after the second stent, and 42% after the third stent (p = 0.6). After the third stent, the rate of target lesion revascularization was 26% (5/19) and target vessel revascularization was 37% (7/19); there was 1 nonfatal myocardial infarction. Thus, the overall rate of major adverse cardiac events was 42%.
While serial restenting a recurrent ISR lesion was not associated with progressive decrease in MSA, it was still associated with chronic stent underexpansion and a high rate of adverse events. Attention should be directed to achieving better stent expansion to minimize subsequent recurrences.
支架用于治疗支架内再狭窄（ISR）的首次甚至后续发作。
在18例患者（19处病变）中，于置入一枚支架治疗非再狭窄病变后，在使用第二枚支架治疗首次ISR发作后以及使用第三枚支架治疗第二次ISR发作后，进行血管内超声（IVUS）检查。第一枚和第二枚支架置入的间隔时间为355±374天，第二枚和第三枚支架置入的间隔时间为330±279天。第三枚支架置入后的随访时间为307±145天。在治疗首次ISR发作时，69%（11/16）的患者进行了高压扩张（>14个大气压），而在治疗再发ISR时所有患者均进行了高压扩张（p = 0.018）。
然而，连续再次置入支架时血管面积和最终最小支架面积（MSA）并未增加，最小支架直径与标称支架尺寸的比值表明慢性支架扩张不足持续存在。第一枚支架置入后54%的患者MSA>5 mm²，第二枚支架置入后为35%，第三枚支架置入后为42%（p = 0.6）。第三枚支架置入后，靶病变血管重建率为26%（5/19），靶血管血管重建率为37%（7/19）；发生1例非致命性心肌梗死。因此，主要不良心脏事件的总体发生率为42%。
虽然对复发性ISR病变进行连续再次置入支架与MSA的逐渐降低无关，但仍与慢性支架扩张不足和高不良事件发生率相关。应致力于实现更好的支架扩张以尽量减少后续复发。
