Division of Cardiology, Yonsei Cardiovascular Center, Yonsei University College of Medicine, Seoul, South Korea.
Am Heart J. 2010 Feb;159(2):278-83. doi: 10.1016/j.ahj.2009.11.029.
Intracoronary thrombus formation after drug-eluting stent (DES) implantation is not sufficiently evaluated.
Optical coherence tomography (OCT) was performed in 226 patients (total DES n = 244, sirolimus-eluting stent [SES] n = 95, paclitaxel-eluting stent [PES] n = 62, zotarolimus-eluting stent [ZES] n = 87) after implantation (mean 11 months, range 3-66 months). Using OCT, we investigated the incidence and determinants of intracoronary thrombus.
Intracoronary thrombus was detected in 35 (14%) cases (27 SES [28%], 7 PES [11%], and 1 ZES [1%], P < .001) and was associated with longer stent, smaller stent diameter, and stents at bifurcation lesions. More uncovered stent struts (26 +/- 23 vs 8 +/- 17, P < .001) and malapposed stent struts (6 +/- 14 vs 2 +/- 6, P < .001) were also associated with intracoronary thrombus. Multiple logistic regression analysis found the following determinants of intracoronary thrombus: stent length > or =28 mm (odds ratio [OR] 7.31, 95% CI 1.79-29.86, P = .01), stent diameter <3.0 mm (OR 4.38, 95% CI 1.38-13.97, P = .01), and > or =8 uncovered struts in each stent (OR 3.29, 95% CI 1.07-10.17, P = .04).
Length, size, and types of DES may be more important than clinical factors in intracoronary thrombus formation after DES implantations.
药物洗脱支架（DES）植入术后的冠状动脉内血栓形成尚未得到充分评估。
对 226 例患者（共 244 个 DES，雷帕霉素洗脱支架[SES]95 个，紫杉醇洗脱支架[PES]62 个，佐他莫司洗脱支架[ZES]87 个）在植入后（平均 11 个月，范围 3-66 个月）进行光学相干断层扫描（OCT）检查。使用 OCT 研究冠状动脉内血栓形成的发生率和决定因素。
35 例（14%）患者发现冠状动脉内血栓（27 个 SES[28%]，7 个 PES[11%]和 1 个 ZES[1%]，P<0.001），且与支架较长、支架直径较小以及分叉病变处支架有关。更多未覆盖的支架支柱（26±23 与 8±17，P<0.001）和支架对位不良（6±14 与 2±6，P<0.001）也与冠状动脉内血栓有关。多因素逻辑回归分析发现冠状动脉内血栓的以下决定因素：支架长度≥28mm（优势比[OR]7.31，95%置信区间 1.79-29.86，P=0.01），支架直径<3.0mm（OR 4.38，95%置信区间 1.38-13.97，P=0.01）和每个支架中≥8 个未覆盖的支柱（OR 3.29，95%置信区间 1.07-10.17，P=0.04）。
DES 的长度、尺寸和类型可能比 DES 植入术后冠状动脉内血栓形成的临床因素更为重要。
