Division of Cardiology, Wakayama National Hospital, Wakayama, Japan.
Am Heart J. 2010 Oct;160(4):775.e1-9. doi: 10.1016/j.ahj.2010.07.010.
Stent fracture is one of the possible causes of in-stent restenosis after sirolimus-eluting stent (SES) implantation. However, long-term prognosis including late restenosis in stent fracture site without early restenosis remains unknown. The aim of this study is to investigate the risk of late restenosis at the stent fracture site without early restenosis after SES implantation.
We divided 366 patients with 490 lesions into 2 groups with or without stent fracture based on the first scheduled follow-up coronary angiography (fracture group, 21 lesions; nonfracture group, 469 lesions). The second scheduled follow-up coronary angiography (>15 months after SES implantation) was performed in 83 patients with 124 lesions.
Target lesion revascularization due to late restenosis at the stent fracture site did not occur in the fracture group, but occurred in 5 lesions in the nonfracture group. At the first follow-up, minimal luminal diameter was significantly smaller and percentage diameter stenosis was significantly larger in the fracture group (1.98 ± 0.41 vs 2.52 ± 0.49 mm, P = .001 and 30.5% ± 13.1% vs 13.0% ± 8.8%, P < .0001, respectively). These differences were also present at the second follow-up (P = .01 and P = .007, respectively). In each group, there were no significant changes in minimal luminal diameter, percentage diameter stenosis, and late lumen loss between the first and second follow-up.
Late restenosis was not observed in stent fracture sites without early restenosis during the midterm follow-up after SES implantation.
支架断裂是西罗莫司洗脱支架（SES）植入后发生支架内再狭窄的可能原因之一。然而，对于没有早期再狭窄的支架断裂部位的晚期再狭窄的长期预后尚不清楚。本研究旨在探讨 SES 植入后无早期再狭窄的支架断裂部位发生晚期再狭窄的风险。
我们根据第一次计划的冠状动脉造影（断裂组 21 个病变，非断裂组 469 个病变）将 366 例 490 个病变的患者分为两组，有或没有支架断裂。对 83 例 124 个病变的患者进行第二次计划的冠状动脉造影（SES 植入后 >15 个月）。
断裂组支架断裂部位的晚期再狭窄导致的靶病变血运重建未发生，但非断裂组有 5 个病变发生。在第一次随访时，断裂组最小管腔直径明显较小，直径狭窄率明显较大（1.98 ± 0.41 比 2.52 ± 0.49mm，P =.001 和 30.5% ± 13.1%比 13.0% ± 8.8%，P <.0001）。第二次随访时也存在这些差异（P =.01 和 P =.007）。在每组中，第一次和第二次随访之间的最小管腔直径、直径狭窄率和晚期管腔丢失均无明显变化。
在 SES 植入后中期随访中，无早期再狭窄的支架断裂部位未观察到晚期再狭窄。
