Miyazawa Akiyoshi, Tsujino Ichizo, Ako Junya, Shimada Yoshihisa, Courtney Brian K, Sakurai Ryota, Nakamura Mamoo, Okura Hiroyuki, Waseda Katsuhisa, Honda Yasuhiro, Fitzgerald Peter J
Center for Cardiovascular Technology, Stanford University Medical Center, 300 Pasteur Drive, Room H3554, Stanford, CA, 94305, USA.
J Invasive Cardiol. 2007 Dec;19(12):515-8.
Late incomplete stent apposition (LISA) develops following implantation of conventional bare-metal stents (BMS) or drug-eluting stents, or after adjunctive intracoronary radiation (IR). However, no study has systematically compared the morphology of LISA seen with various treatment modalities.
To compare the morphometric features of LISA accompanying BMS, IR or sirolimus-eluting stents (SES) using serial intravascular ultrasound (IVUS).
A query of Stanford University's IVUS database of the Cardiovascular Core Analysis Laboratory was performed to identify LISA cases. Dedicated software programs were used for volumetric IVUS analyses.
In 30 LISA cases (12 BMS, 6 IR and 12 SES), there was no intertreatment difference in the degree of LISA (lumen area minus stent area at follow up). Serial analyses of LISA segments showed that vessel area of SES and IR showed significant increase at follow up as compared with post procedure, while there was no significant change in plaque area. In contrast, the BMS group showed no increase in vessel area, whereas plaque area revealed significant reduction. Eight of 12 BMS cases were treated by directional atherectomy before stenting; however, there was no difference in the area change between patients with or without pre-stent atherectomy. Post-procedure plaque thickness beneath the stent struts of LISA was thinner for SES as compared with BMS.
Plaque reduction primarily contributes to LISA after BMS, whereas vessel expansion is the predominant factor in LISA development for IR and SES. Thus, the mechanism of LISA may vary among different interventional treatments.
晚期支架贴壁不全（LISA）在传统裸金属支架（BMS）、药物洗脱支架植入后或冠状动脉内辅助放射治疗（IR）后出现。然而，尚无研究系统比较不同治疗方式下LISA的形态。
使用连续血管内超声（IVUS）比较BMS、IR或西罗莫司洗脱支架（SES）相关LISA的形态测量形态测量特征。
查询斯坦福大学心血管核心分析实验室的IVUS数据库以识别LISA病例。使用专用软件程序进行IVUS容积分析。
在30例LISA病例（12例BMS、6例IR和12例SES）中，不同治疗方式的LISA程度（随访时管腔面积减去支架面积）无差异。对LISA节段的连续分析显示，SES和IR的血管面积在随访时较术后显著增加，而斑块面积无显著变化。相比之下，BMS组血管面积无增加，而斑块面积显著减小。12例BMS病例中有8例在支架置入前接受了定向斑块旋切术；然而，支架置入前是否接受斑块旋切术的患者之间面积变化无差异。与BMS相比，SES的LISA支架支柱下方的术后斑块厚度更薄。
BMS术后LISA主要由斑块缩小导致，而血管扩张是IR和SES术后LISA发展的主要因素。因此，不同介入治疗中LISA的机制可能不同。
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