Hecht Harvey S, Polena Sotir, Jelnin Vladimir, Jimenez Marcelo, Bhatti Tandeep, Parikh Manish, Panagopoulos Georgia, Roubin Gary
Lenox Hill Heart & Vascular Institute, New York, New York, USA.
J Am Coll Cardiol. 2009 Nov 17;54(21):1949-59. doi: 10.1016/j.jacc.2009.06.045.
The goal of this study was to define the frequency of stent gaps by 64-detector computed tomographic angiography (CTA) and their relation to in-stent restenosis (ISR), stent fracture (SF), and overlap failure (OF).
SF defined by catheter angiography or intravascular ultrasound has been implicated in ISR.
A total of 292 consecutive patients, with 613 stents, who underwent CTA were evaluated for stent gaps associated with decreased Hounsfield units. Correlations with catheter coronary angiography (CCA) were available in 143 patients with 384 stents.
Stent gaps were noted in 16.9% by CTA and 1.0% by CCA. ISR by CCA was noted in 46.1% of the stent gaps (p < 0.001) as determined by CCA, and stent gaps by CTA accounted for 27.8% of the total ISR (p < 0.001). In univariate analysis, stent diameter > or =3 mm was the only CCA characteristic significantly associated with stent gaps (p = 0.002), but was not a significant predictor by multivariate analysis. Bifurcation stents, underlying calcification, stent type, location, post-dilation, and overlapping stents were not observed to be predisposing factors. Excessive tortuosity and lack of conformability were not associated with stent gaps; however, their frequency was insufficient to permit meaningful analysis.
Stent gap by CTA: 1) is associated with 28% of ISR, and ISR is found in 46% of stent gaps; 2) is associated with > or =3-mm stents by univariate (p = 0.002) but not by multivariate analysis; 3) is infrequently noted on catheter angiography; and 4) most likely represents SF in the setting of a single stent, and may represent SF or OF in overlapping stents.
本研究的目的是通过64层螺旋CT血管造影（CTA）确定支架间隙的发生率及其与支架内再狭窄（ISR）、支架断裂（SF）和重叠失败（OF）的关系。
导管血管造影或血管内超声所定义的SF与ISR有关。
对连续292例接受CTA检查的患者（共613个支架）进行评估，以确定与亨氏单位降低相关的支架间隙。143例患者（384个支架）可获得与导管冠状动脉造影（CCA）的相关性。
CTA显示支架间隙发生率为16.9%，CCA显示为1.0%。CCA确定的支架间隙中，46.1%出现了CCA定义的ISR（p<0.001），CTA显示的支架间隙占总ISR的27.8%（p<0.001）。单因素分析中，支架直径≥3mm是唯一与支架间隙显著相关的CCA特征（p=0.002），但多因素分析中并非显著预测因素。未观察到分叉支架、潜在钙化、支架类型、位置、后扩张及重叠支架是易患因素。过度迂曲和顺应性不足与支架间隙无关；然而，其发生率不足以进行有意义的分析。
CTA显示的支架间隙：1）与28%的ISR相关，46%的支架间隙存在ISR；2）单因素分析显示与直径≥3mm的支架相关（p=0.002），多因素分析则不然；3）在导管血管造影中很少见；4）在单个支架情况下很可能代表SF，在重叠支架中可能代表SF或OF。
