Department of Cardiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea.
Am J Cardiol. 2010 May 15;105(10):1402-8. doi: 10.1016/j.amjcard.2009.12.064. Epub 2010 Apr 8.
Using serial volumetric intravascular ultrasonography, we evaluated the predictors of late intimal hyperplasia (IH) increases after drug-eluting stent implantation. All eligible patients who underwent 6-month angiography without visual restenosis were requested to undergo a 2-year follow-up examination. Complete serial (after stenting and early [6-month], and late [2-year] follow-up) angiographic and intravascular ultrasound data were available for 135 patients with 143 lesions: 99 sirolimus-eluting stents and 44 paclitaxel-eluting stents. The external elastic membrane, stent, lumen, and peri-stent plaque volumes (external elastic membrane minus stent) were normalized by stent length. The percentage of IH volume was calculated as IH volume/stent volume x 100. The early reduction in the minimum lumen area was greater than the late reduction in the minimum lumen area (-0.8 +/- 0.8 vs -0.2 +/- 0.5 mm(2), p <0.001). A progressive increase occurred in the percentage of IH volume: 8.1 +/- 7.1% from baseline to 6 months and 2.4 +/- 3.9% from 6 months to 2 years (p <0.001, between the early and late increases in the percentage of IH). The use of paclitaxel-eluting stents was the only independent predictor for the percentage of IH volume at 6 months (beta = 0.419, p <0.001). The use of paclitaxel-eluting stents (beta = 0.365, p <0.001, 95% confidence interval 3.7 to 9.7) and the post-stenting normalized plaque and media volume (beta = 0.195, p = 0.020, 95% confidence interval 0.1 to 1.6) were the only independent predictors for the percentage of IH volume at 2 years. However, when the percentage of IH at 6 months was forced into the model, the percentage of IH at 6 months and the post-stenting normalized plaque and media volume, not paclitaxel-eluting stent use, predicted the 2-year percentage of IH. In conclusion, although IH continued to increase beyond 6 months, the growth rate of intima and luminal loss attenuated with time.
使用连续容积血管内超声，我们评估了药物洗脱支架植入后晚期内膜增生（IH）增加的预测因素。所有接受 6 个月血管造影且无视觉再狭窄的合格患者均被要求进行 2 年随访检查。135 名患者的 143 个病变部位有完整的连续（支架后、早期[6 个月]和晚期[2 年]随访）血管造影和血管内超声数据：99 个西罗莫司洗脱支架和 44 个紫杉醇洗脱支架。外部弹性膜、支架、管腔和支架周围斑块体积（外部弹性膜减去支架）按支架长度归一化。IH 体积百分比计算为 IH 体积/支架体积 x 100。早期最小管腔面积减少大于晚期最小管腔面积减少（-0.8 +/- 0.8 比-0.2 +/- 0.5mm(2)，p <0.001）。IH 体积百分比呈渐进性增加：从基线到 6 个月增加 8.1 +/- 7.1%，从 6 个月到 2 年增加 2.4 +/- 3.9%（p <0.001，早期和晚期 IH 体积百分比增加之间）。紫杉醇洗脱支架的使用是 6 个月时 IH 体积百分比的唯一独立预测因子（β=0.419，p <0.001）。紫杉醇洗脱支架的使用（β=0.365，p <0.001，95%置信区间 3.7 至 9.7）和支架置入后标准化斑块和中膜体积（β=0.195，p=0.020，95%置信区间 0.1 至 1.6）是 2 年后 IH 体积百分比的唯一独立预测因子。然而，当 6 个月时 IH 的百分比被强制纳入模型时，6 个月时 IH 的百分比和支架置入后标准化斑块和中膜体积，而不是紫杉醇洗脱支架的使用，预测了 2 年时 IH 的百分比。总之，尽管 IH 在 6 个月后仍继续增加，但内膜和管腔损失的增长率随时间减弱。
