Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
Circulation. 2011 May 31;123(21):2382-91. doi: 10.1161/CIRCULATIONAHA.110.003459. Epub 2011 May 16.
We have noted abnormal angiographic findings--at the sites of drug-eluting stent implantation, suggesting contrast staining outside the stent struts--that do not fulfill the classic definition of coronary artery aneurysm. We propose a new term, peri-stent contrast staining (PSS), for these abnormal angiographic findings and assess their incidence, risk factors, and clinical sequelae.
Peri-stent contrast staining was defined as contrast staining outside the stent contour extending to ≥20% of the stent diameter. The study population consisted of 3081 lesions (1998 patients) that were treated exclusively with sirolimus-eluting stents and were evaluated by follow-up angiography within 12 months after sirolimus-eluting stent implantation in a single center. Late acquired PSS was observed in 58 lesions (1.9%) in 49 patients (2.5%). Independent risk factors of PSS included chronic total occlusion, whereas negative risk factors for PSS were left circumflex coronary artery lesion and in-stent restenosis lesion. Stent fracture was more frequently observed in lesions with PSS than in lesions without PSS (43.1% versus 5.4%, P<0.0001). Excluding 269 lesions with target-lesion revascularization within 12 months, the study population for long-term follow-up consisted of 51 lesions (42 patients) with PSS and 2761 lesions (1751 patients) without PSS. Cumulative incidence of target-lesion revascularization and definite very late stent thrombosis at 3 years in the PSS group was higher than that in the non-PSS group (15.0% versus 6.5%, and 8.2% versus 0.2%, respectively).
Peri-stent contrast staining found within 12 months after sirolimus-eluting stent implantation appeared to be associated with subsequent target-lesion revascularization and very late stent thrombosis.
我们观察到一种异常的血管造影表现——在药物洗脱支架植入部位，可见支架小梁外的对比染色，不符合冠状动脉瘤的经典定义。我们提出了一个新术语，即支架周围对比染色（PSS），用于描述这些异常血管造影表现，并评估其发生率、危险因素和临床后果。
支架周围对比染色定义为支架轮廓外的对比染色延伸至支架直径的≥20%。本研究人群由 3081 处病变（1998 例患者）组成，这些病变均采用西罗莫司洗脱支架进行治疗，在单中心接受随访血管造影检查，评估时间为西罗莫司洗脱支架植入后 12 个月内。在 49 例患者（2.5%）的 58 处病变（1.9%）中观察到迟发性获得性 PSS。PSS 的独立危险因素包括慢性完全闭塞，而 PSS 的阴性危险因素包括左回旋支病变和支架内再狭窄病变。支架断裂在有 PSS 的病变中比无 PSS 的病变更常见（43.1%比 5.4%，P<0.0001）。排除 12 个月内靶病变血运重建的 269 处病变后，长期随访研究人群包括 51 处病变（42 例患者）有 PSS 和 2761 处病变（1751 例患者）无 PSS。PSS 组在 3 年时的靶病变血运重建和明确的极晚期支架血栓形成发生率高于无 PSS 组（分别为 15.0%比 6.5%和 8.2%比 0.2%）。
西罗莫司洗脱支架植入后 12 个月内发现的支架周围对比染色似乎与随后的靶病变血运重建和极晚期支架血栓形成有关。
