Aoki Jiro, Mintz Gary S, Weissman Neil J, Mann J Tift, Cannon Louis, Greenberg Joel, Grube Eberhard, Masud A R Zaki, Koglin Joerg, Mandinov Lazar, Stone Gregg W
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York 10022, USA.
JACC Cardiovasc Interv. 2008 Apr;1(2):161-7. doi: 10.1016/j.jcin.2007.12.005.
The purpose of this study was to use intravascular ultrasound (IVUS) to investigate chronic arterial responses at the site of and adjacent to overlapping paclitaxel-eluting TAXUS stents (PES) compared with overlapping bare-metal stents (BMS).
Increased paclitaxel dose in the PES-overlap region might be associated with arterial toxicity expressed as excessive expansive remodeling, incomplete stent apposition, or aneurysm formation.
In the TAXUS-V and -VI trials, 51 patients with overlapping stents (27 PES and 24 BMS) were imaged with serial IVUS immediately after procedure and at 9 months. The IVUS measurements included intimal hyperplasia (IH), peri-stent plaque plus media (P&M), and external elastic membrane (EEM) areas. Vascular responses were assessed at the proximal and distal single stent strut regions and the central overlap region.
Compared with BMS, all 3 PES stent regions showed: 1) significantly decreased IH (proximal: 0.97 +/- 1.06 mm(2) vs. 3.12 +/- 2.40 mm(2), overlap: 0.74 +/- 0.91 mm(2) vs. 3.23 +/- 1.75 mm(2), distal: 0.88 +/- 0.85 mm(2) vs. 2.69 +/- 1.49 mm(2), all p < 0.05); and 2) increased P&M and EEM areas (Delta P&M, proximal: 0.96 +/- 1.36 mm(2) vs. -0.02 +/- 1.48 mm(2), overlap: 1.56 +/- 1.88 mm(2) vs. 0.29 +/- 1.82 mm(2), distal: 1.03 +/- 1.81 mm(2) vs. 0.11 +/- 0.89 mm(2), all p < 0.05). The IH and changes in EEM and P&M areas were not significantly different in both the BMS and PES groups comparing the single stent strut and overlap regions. Incomplete stent apposition did not occur at the site of overlapping PES in any patient.
Nine months after stent implantation, neointimal tissue growth was reduced and expansive remodeling was greater with PES compared with BMS--effects that were not exaggerated at the overlap region of PES.
本研究旨在使用血管内超声（IVUS）研究与裸金属支架（BMS）重叠相比，紫杉醇洗脱TAXUS支架（PES）重叠部位及其相邻部位的慢性动脉反应。
PES重叠区域中紫杉醇剂量增加可能与动脉毒性有关，表现为过度的扩张性重塑、支架贴壁不全或动脉瘤形成。
在TAXUS-V和-VI试验中，51例有重叠支架的患者（27例PES和24例BMS）在术后即刻和9个月时接受了连续IVUS成像。IVUS测量包括内膜增生（IH）、支架周围斑块加中膜（P&M）和外弹力膜（EEM）面积。在近端和远端单个支架支柱区域以及中央重叠区域评估血管反应。
与BMS相比，所有3个PES支架区域均显示：1）IH显著降低（近端：0.97±1.06mm²对3.12±2.40mm²，重叠处：0.74±0.91mm²对3.23±1.75mm²，远端：0.88±0.85mm²对2.69±1.49mm²，所有p<0.05）；2）P&M和EEM面积增加（ΔP&M，近端：0.96±1.36mm²对-0.02±1.48mm²，重叠处：1.56±1.88mm²对0.29±1.82mm²，远端：1.03±1.81mm²对0.11±0.89mm²，所有p<0.05）。在比较单个支架支柱和重叠区域时，BMS组和PES组的IH以及EEM和P&M面积变化无显著差异。在任何患者的PES重叠部位均未发生支架贴壁不全。
支架植入9个月后，与BMS相比，PES的新生内膜组织生长减少且扩张性重塑更大——这些效应在PES的重叠区域并未被夸大。
