Nakazawa Gaku, Finn Aloke V, Vorpahl Marc, Ladich Elena, Kutys Robert, Balazs Isidora, Kolodgie Frank D, Virmani Renu
CVPath Institute, Inc., Gaithersburg, Maryland, USA.
J Am Coll Cardiol. 2009 Nov 17;54(21):1924-31. doi: 10.1016/j.jacc.2009.05.075.
The aim of this study was to perform pathologic assessment on stent fracture.
Clinically, stent fracture has been reported in 1% to 2% of patients after drug-eluting stent (DES) implantation.
High-contrast film-based radiographs of 177 consecutive lesions from the CVPath DES autopsy registry were reviewed. Stent fracture was graded as I (single-strut fracture), II (> or =2 struts), III (> or =2 struts with deformation), IV (with transection without gap), and V (with transection causing gap in stent segment). The incidence of adverse pathologic findings (thrombosis and restenosis) was assessed histologically.
Stent fracture was documented in 51 lesions (29%; grade I = 10, II = 14, III = 12, IV = 6, and V = 9). Lesions with stent fracture had longer duration after implantation (172 days [interquartile range (IQR) 31 to 630 days] vs. 44 days [IQR 7 to 270 days], p = 0.004), a higher rate of Cypher (Cordis Corp., Miami Lakes, Florida) stent usage (63% vs. 36%, p = 0.001), longer stent length (30.0 mm [IQR 22.0 to 40.0 mm] vs. 20.0 mm [IQR 14.0 to 27.3 mm], p < 0.0001), and a higher rate of overlapping stents (45% vs. 22%, p = 0.003). Although fracture with grade I to IV did not have significant impact on the occurrence of adverse pathologic findings such as thrombosis and restenosis, 67% of the grade V fracture lesions were associated with adverse pathologic findings at fracture sites. Longer stent length, use of Cypher, and longer duration of implant were identified as independent risk factors of stent fracture by logistic regression analysis.
The incidence of stent fracture was 29% lesions at autopsy, which is much higher than clinically reported. A high rate of adverse pathologic findings was observed in lesions with grade V stent fracture, whereas fracture with grade I to IV did not have a significant impact on the pathological outcome.
本研究旨在对支架断裂进行病理学评估。
临床上，药物洗脱支架（DES）植入术后1%至2%的患者曾有支架断裂的报道。
回顾了CVPath DES尸检登记处177个连续病变的高对比度胶片X线片。支架断裂分为I级（单支柱断裂）、II级（≥2个支柱）、III级（≥2个支柱且有变形）、IV级（有横断但无间隙）和V级（有横断导致支架节段出现间隙）。通过组织学评估不良病理结果（血栓形成和再狭窄）的发生率。
51个病变（29%）记录有支架断裂（I级 = 10个，II级 = 14个，III级 = 12个，IV级 = 6个，V级 = 9个）。有支架断裂的病变植入后持续时间更长（172天[四分位间距（IQR）31至630天] vs. 44天[IQR 7至270天]，p = 0.004），Cypher（科迪斯公司，佛罗里达州迈阿密湖）支架使用率更高（63% vs. 36%，p = 0.001），支架长度更长（30.0 mm[IQR 22.0至40.0 mm] vs. 20.0 mm[IQR 14.0至27.3 mm]，p < 0.0001），以及重叠支架使用率更高（45% vs. 22%，p = 0.003）。虽然I至IV级断裂对血栓形成和再狭窄等不良病理结果的发生没有显著影响，但67%的V级断裂病变在断裂部位伴有不良病理结果。通过逻辑回归分析确定，较长的支架长度、使用Cypher支架和较长的植入持续时间是支架断裂的独立危险因素。
尸检时支架断裂的发生率为病变的29%，远高于临床报道。V级支架断裂的病变观察到较高的不良病理结果发生率，而I至IV级断裂对病理结果没有显著影响。
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