Higo Tomoaki, Ueda Yasunori, Oyabu Jota, Okada Katsuki, Nishio Mayu, Hirata Akio, Kashiwase Kazunori, Ogasawara Nobuyuki, Hirotani Shinichi, Kodama Kazuhisa
Cardiovascular Division, Osaka Police Hospital, Osaka, Japan.
JACC Cardiovasc Imaging. 2009 May;2(5):616-24. doi: 10.1016/j.jcmg.2008.12.026.
We sought to examine by angioscopy the neointima formation and thrombogenic potential of the neointima after deployment of a drug-eluting stent (DES).
Late stent thrombosis after DES implantation, a major safety concern, has been associated with poor strut coverage by neointima. Intracoronary angioscopy provides a method for visual evaluation of stent coverage by neointima and detection of thrombus in the stented coronary segment.
Patients undergoing implantation of a sirolimus DES (n = 57) were serially examined by angioscopy immediately after (baseline) and again at 10 months (follow-up) after implantation. The angioscopic color grade of the neointima from white to yellow was assessed in a semiquantitative manner. Stent coverage was classified into not covered (Grade 0), covered by a thin layer (Grade 1), or buried under neointima (Grade 2). The thrombogenic potential of the neointima was evaluated by the prevalence of thrombus on the neointima.
The maximum yellow color grade of the neointima within DES-implanted lesions increased significantly from baseline to follow-up (1.4 +/- 1.1 vs. 1.9 +/- 0.6, p = 0.0008). Even among lesions without yellow color at baseline, yellow color was detected in 94% (17 of 18) of lesions at follow-up. The prevalence of thrombus was significantly higher on the yellow than on the white neointimal areas. Thrombus was detected on yellow and/or Grade-0/1 neointima, but never on the white Grade-2 neointima.
Sirolimus DES promoted formation of atherosclerotic yellow neointima in the stent-implanted lesion at 10-month follow-up. Thrombus was detected more often on the yellow area than on the white area and was never detected where a stent was buried under white neointima. These data suggest that the increased potential risk of late stent thrombosis in DES lesions may be due to the newly formed yellow neotima and cholesterol-laden plaque.
我们试图通过血管内镜检查药物洗脱支架（DES）植入后新生内膜的形成情况及新生内膜的致血栓形成潜能。
DES植入后晚期支架血栓形成是一个主要的安全问题，与新生内膜对支架小梁的覆盖不佳有关。冠状动脉内血管内镜提供了一种可视化评估新生内膜对支架覆盖情况以及检测支架置入冠状动脉节段内血栓的方法。
对接受西罗莫司DES植入的患者（n = 57）在植入后即刻（基线）及植入后10个月（随访）通过血管内镜进行连续检查。以半定量方式评估新生内膜从白色到黄色的血管内镜颜色分级。支架覆盖情况分为未覆盖（0级）、被薄层覆盖（1级）或被新生内膜包埋（2级）。通过新生内膜上血栓的发生率评估新生内膜的致血栓形成潜能。
DES植入病变内新生内膜的最大黄色分级从基线到随访时显著增加（1.4±1.1对1.9±0.6，p = 0.0008）。即使在基线时无黄色的病变中，随访时94%（18个中的17个）的病变检测到黄色。黄色新生内膜区域的血栓发生率显著高于白色区域。在黄色和/或0/1级新生内膜上检测到血栓，但在白色2级新生内膜上从未检测到血栓。
在10个月随访时，西罗莫司DES促进了支架植入病变内动脉粥样硬化黄色新生内膜的形成。黄色区域比白色区域更常检测到血栓，且在白色新生内膜包埋支架处从未检测到血栓。这些数据表明，DES病变中晚期支架血栓形成的潜在风险增加可能归因于新形成的黄色新生内膜和富含胆固醇的斑块。
