Opolski Maksymilian P, Pracon Radoslaw, Mintz Gary S, Okabe Teruo, Pregowski Jerzy, Lee Sung Yun, van der Waal Eva C, Kalinczuk Lukasz, Roy Probal, Smith Kimberly A, Torguson Rebecca, Xue Zhenyi, Satler Lowell F, Kent Kenneth M, Pichard Augusto D, Waksman Ron, Weissman Neil J
Cardiovascular Research Institute, Washington Hospital Center, Washington, DC, USA.
Am J Cardiol. 2009 Aug 1;104(3):343-8. doi: 10.1016/j.amjcard.2009.03.047. Epub 2009 Jun 6.
The distribution of stent struts is critical to drug deposition and, therefore, may affect the amount of neointima and the risk of thrombosis after drug-eluting stent (DES) implantation. The aim of our study was to evaluate stent strut distribution in the setting of a drug-eluting stent thrombosis (ST). We retrospectively analyzed postprocedural intravascular ultrasound (IVUS) images of 13 patients who subsequently developed ST (14 DES thrombotic lesions) and a control group of 27 patients (30 DES lesions) matched for stent type and presence of chronic renal failure. In addition to standard IVUS measurements, visible struts were counted and maximum interstrut angle was measured at 1-mm intervals. Early ST was defined as < or =30 days after DES deployment and late ST as >30 days after DES deployment. Compared with DES controls, the ST group had a larger maximum interstrut angle (60.8 +/- 8.3 degrees vs 55.7 +/- 4.8 degrees , p = 0.014) and a similar number of stent struts (8.4 +/- 0.6 vs 8.7 +/- 0.6, p = NS). Maximum interstrut angle tended to be larger in late ST than in early ST (66.1 +/- 10.8 degrees vs 57.8 +/- 5.0 degrees , p = 0.071). The incidence of maximum interstrut angles > or =90 degrees and > or =120 degrees observed continuously for > or =2 mm of stent length was higher in the ST group (p = 0.009 and p = 0.096, respectively). In conclusion, DES-treated lesions leading to ST had larger maximum interstrut gaps distributed circumferentially and longitudinally, but a similar number of struts at the time of DES implantation compared with DES controls.
支架撑条的分布对于药物沉积至关重要，因此可能会影响药物洗脱支架（DES）植入后新生内膜的数量以及血栓形成的风险。我们研究的目的是评估药物洗脱支架血栓形成（ST）情况下的支架撑条分布。我们回顾性分析了13例随后发生ST的患者（14个DES血栓形成病变）以及27例（30个DES病变）匹配了支架类型和慢性肾衰竭情况的对照组患者的术后血管内超声（IVUS）图像。除了标准的IVUS测量外，还对可见撑条进行计数，并以1毫米的间隔测量最大撑条间角度。早期ST定义为DES置入后≤30天，晚期ST定义为DES置入后>30天。与DES对照组相比，ST组的最大撑条间角度更大（60.8±8.3度对55.7±4.8度，p = 0.014），且支架撑条数量相似（8.4±0.6对8.7±0.6，p =无显著性差异）。晚期ST的最大撑条间角度往往比早期ST更大（66.1±10.8度对57.8±5.0度，p = 0.071）。ST组中观察到支架长度连续≥2毫米的最大撑条间角度≥90度和≥120度的发生率更高（分别为p = 0.009和p = 0.096）。总之，与DES对照组相比，导致ST的DES治疗病变在圆周和纵向分布上有更大的最大撑条间间隙，但在DES植入时撑条数量相似。
