Tsujino Ichizo, Koizumi Tomomi, Shimohama Takao, Ako Junya, Waseda Katsuhisa, Krucoff Mitchell, Honda Yasuhiro, Fitzgerald Peter J
Division of Cardiovascular Medicine, Stanford University Medical Center, Stanford, CA 94305, USA.
Cardiovasc Revasc Med. 2012 Mar-Apr;13(2):111-8. doi: 10.1016/j.carrev.2012.01.010. Epub 2012 Mar 8.
Dedicated IVUS analyses of the second CObalt chromium STent with Antiproliferative for Restenosis (COSTAR II) trial have not been documented. We aim to compare IVUS findings between CoStar paclitaxel-eluting stent (PES) and Taxus PES in patients enrolled in the COSTAR II trial. We also attempted to examine the possible regional impact of multiple stenting.
Among the 1700 patients enrolled, 238 were assigned to an IVUS cohort including 168 patients treated by provisional multiple stenting. At 9 months, qualitative and quantitative IVUS observations including incomplete stent apposition (ISA) and neointimal proliferation (neointimal obstruction: neointimal volume/stent volume ×100) were compared between CoStar and Taxus PESs.
In qualitative analysis, late-acquired ISA was observed in 1 patient treated by Taxus PES. Impaired strut continuity suggestive of stent fracture was observed in 2 out of 33 patients treated by multiple CoStar, and 4 out of 21 patients treated by multiple Taxus (P=.14). No such findings were found in single-stented patients in either stent subset. Quantitative analysis showed greater neointimal obstruction in CoStar (19.7%±13.4%, n=52) than in Taxus (10.7%±9.9%, n=38), whereas no significant difference in neointimal obstruction was found between single and multiple stenting in either CoStar or Taxus PES.
The CoStar PES exhibits greater neointimal proliferation compared with Taxus PES at 9 months but with similar qualitative outcomes including late-acquired ISA. IVUS findings suggestive of stent fracture were found only in multiple-stenting cases irrespective of the stent used.
尚无关于第二代含抗增殖药物的钴铬合金支架治疗再狭窄（COSTAR II）试验的专用血管内超声（IVUS）分析的文献记载。我们旨在比较COSTAR II试验中入组患者使用的CoStar紫杉醇洗脱支架（PES）和Taxus PES的IVUS结果。我们还试图研究多支架置入可能产生的局部影响。
在1700名入组患者中，238名被分配到IVUS队列，其中包括168名接受临时多支架置入治疗的患者。在9个月时，比较了CoStar和Taxus PES在定性和定量IVUS观察结果，包括支架贴壁不全（ISA）和新生内膜增殖（新生内膜阻塞：新生内膜体积/支架体积×100）。
在定性分析中，1名接受Taxus PES治疗的患者出现迟发性ISA。在33名接受多个CoStar支架治疗的患者中，有2名观察到提示支架断裂的支架支柱连续性受损；在21名接受多个Taxus支架治疗的患者中，有4名观察到这种情况（P = 0.14）。在任一支架亚组的单支架置入患者中均未发现此类情况。定量分析显示，CoStar组（19.7%±13.4%，n = 52）的新生内膜阻塞程度高于Taxus组（10.7%±9.9%，n = 38），而在CoStar或Taxus PES中，单支架置入和多支架置入的新生内膜阻塞程度无显著差异。
在9个月时，CoStar PES与Taxus PES相比，新生内膜增殖更明显，但在包括迟发性ISA在内的定性结果方面相似。无论使用何种支架，仅在多支架置入病例中发现提示支架断裂的IVUS结果。
