Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
JACC Cardiovasc Interv. 2009 Oct;2(10):997-1004. doi: 10.1016/j.jcin.2009.07.012.
We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections after drug-eluting stent (DES) implantation.
DES implantation strategies differ compared with bare-metal stenting; coronary dissections after DES implantation have not been well studied.
We studied 887 patients with 1,045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging.
Eighty-two dissections were detected; 51.2% (42 of 82) involved the proximal and 48.8% (40 of 82) the distal stent edge. Residual plaque area (8.0 +/- 4.3 mm(2) vs. 5.2 +/- 3.0 mm(2), p < 0.0001); plaque burden (52.2 +/- 11.7% vs. 36.2 +/- 15.3%, p < 0.0001); plaque eccentricity (8.4 +/- 5.5 vs. 4.0 +/- 3.4, p < 0.0001); and stent edge symmetry (1.2 +/- 0.1 vs. 1.1 +/- 0.1, p = 0.02) were larger; plaque burden > or =50% was more frequent (62.0% vs. 17.2%, p < 0.0001); calcium deposits (52.1% vs. 35.2%, p = 0.03) more common; and lumen-to-stent-edge-area ratio (0.9 +/- 0.2 vs. 1.0 +/- 0.2, p < 0.0001) was smaller in the edge dissection group compared with the nondissection group. Intramural hematomas occurred in 34.1% (28 of 82) of dissections. When compared with nonhematoma dissections, residual plaque and media area (6.4 +/- 2.5 mm(2) vs. 8.9 +/- 4.6 mm(2), p = 0.04) was smaller, and stent edges less asymmetric (1.1 +/- 0.1 vs. 1.2 +/- 0.1, p = 0.009) in the dissection with hematoma group. Independent predictors of any stent edge dissection were residual plaque eccentricity (odds ratio [OR]: 1.4, p = 0.02), lumen-to-stent-edge-area ratio (OR: 0.0, p = 0.007), and stent edge symmetry (OR: 1.2, p = 0.02 for each 0.01 increase).
IVUS identified edge dissections after 9.2% of DES implantations. Residual plaque eccentricity, lumen-to-stent-edge-area ratio, and stent edge symmetry predicted coronary stent edge dissections. Dissections in less diseased reference segments more often evolved into an intramural hematoma.
我们使用血管内超声（IVUS）评估药物洗脱支架（DES）植入后边缘夹层的发生率、预测因素、形态和血管造影表现。
DES 植入策略与裸金属支架不同；DES 植入后冠状动脉夹层尚未得到很好的研究。
我们研究了 887 例 977 个原生动脉中 1045 个非支架内再狭窄病变接受 DES 植入并进行 IVUS 成像的患者。
共发现 82 处夹层，51.2%（42/82）累及近端支架边缘，48.8%（40/82）累及远端支架边缘。残留斑块面积（8.0 ± 4.3mm2 比 5.2 ± 3.0mm2，p<0.0001）；斑块负荷（52.2 ± 11.7% 比 36.2 ± 15.3%，p<0.0001）；斑块偏心度（8.4 ± 5.5 比 4.0 ± 3.4，p<0.0001）；支架边缘对称性（1.2 ± 0.1 比 1.1 ± 0.1，p=0.02）更大；斑块负荷>或=50%更常见（62.0% 比 17.2%，p<0.0001）；钙沉积（52.1% 比 35.2%，p=0.03）更常见；夹层组与非夹层组相比，管腔至支架边缘面积比（0.9 ± 0.2 比 1.0 ± 0.2，p<0.0001）更小。夹层中有 34.1%（28/82）发生壁内血肿。与非血肿夹层相比，血肿组的残留斑块和中膜面积（6.4 ± 2.5mm2 比 8.9 ± 4.6mm2，p=0.04）较小，支架边缘对称性（1.1 ± 0.1 比 1.2 ± 0.1，p=0.009）较小。支架边缘任何部位夹层的独立预测因素是残留斑块偏心度（比值比[OR]：1.4，p=0.02）、管腔至支架边缘面积比（OR：0.0，p=0.007）和支架边缘对称性（OR：每增加 0.01，p=0.02）。
IVUS 发现 DES 植入后 9.2%的边缘夹层。残留斑块偏心度、管腔至支架边缘面积比和支架边缘对称性预测冠状动脉支架边缘夹层。病变参考节段较少的夹层更常发展为壁内血肿。
