Interventional Cardiology Department, Thoraxcenter, Erasmus MC, 's Gravendijkwal 230, Rotterdam, The Netherlands.
Eur Heart J. 2012 Jun;33(11):1325-33. doi: 10.1093/eurheartj/ehr466. Epub 2012 Apr 16.
To analyse the vasoreactivity of a coronary segment, previously scaffolded by the ABSORB bioresorbable vascular scaffold (BVS) device, in relationship to its intravascular ultrasound-virtual histology (IVUS-VH) composition and reduction in greyscale echogenicity of the struts. Coronary segments, transiently scaffolded by a polymeric device, may in the long-term recover a normal vasomotor tone. Recovery of a normal endothelial-dependent vasomotion may be enabled by scaffold bioresorption, composition of the underlying tissue, or a combination of both mechanisms.
All patients from the ABSORB Cohort A and B trials, who underwent a vasomotion test and IVUS-VH investigation at 12 and 24 months, were included. Acetylcholine (Ach) and nitroglycerin were used to test either the endothelial-dependent or -independent vasomotion of the treated segment. Changes in polymeric strut echogenicity-a surrogate for bioresorption-IVUS-VH composition of the tissue underneath the scaffold and their relationship with the pharmacologically induced vasomotion were all evaluated. Overall, 26 patients underwent the vasomotion test (18 at 12 and 8 at 24 months). Vasodilatory response to Ach was quantitatively associated with larger reductions over time in polymeric strut echogenicity (y= -0.159x- 6.85; r= -0.781, P< 0.001). Scaffolded segments with vasoconstriction to Ach had larger vessel areas (14.37 ± 2.50 vs. 11.85 ± 2.54 mm(2), P= 0.030), larger plaque burden (57.31 ± 5.96 vs. 49.09 ± 9.10%, P= 0.018), and larger necrotic core (NC) areas [1.39 (+1.14, +1.74) vs. 0.78 mm(2) (+0.20, +0.98), P= 0.006] compared with those with vasodilation.
Vasodilatory response to Ach, in coronary segments scaffolded by the ABSORB BVS device, is associated with a reduction in echogenicity of the scaffold over time, and a low amount of NC. In particular, the latter finding resembles the behaviour of a native coronary artery not caged by an intracoronary device.
分析先前用 ABSORB 生物可吸收血管支架（BVS）装置支架的冠状动脉段的血管反应性，与血管内超声虚拟组织学（IVUS-VH）组成和支架中灰度回声强度的降低有关。用聚合物装置短暂支架的冠状动脉段在长期内可能恢复正常的血管舒缩功能。支架生物吸收、底层组织的组成或这两种机制的结合可能使内皮依赖性血管运动得以恢复。
纳入所有接受血管运动试验和 12 个月及 24 个月 IVUS-VH 检查的 ABSORB 队列 A 和 B 试验患者。使用乙酰胆碱（Ach）和硝酸甘油来测试治疗节段的内皮依赖性或非依赖性血管运动。评估聚合物支架回声强度变化（生物吸收的替代物）、支架下组织的 IVUS-VH 组成及其与药物诱导血管运动的关系。共有 26 例患者接受了血管运动试验（12 个月时 18 例，24 个月时 8 例）。Ach 引起的血管舒张反应与聚合物支架回声强度随时间的定量降低呈负相关（y=-0.159x-6.85；r=-0.781，P<0.001）。Ach 引起血管收缩的支架节段血管面积较大（14.37±2.50 vs. 11.85±2.54mm2，P=0.030），斑块负荷较大（57.31±5.96 vs. 49.09±9.10%，P=0.018），坏死核心（NC）面积较大[1.39（+1.14，+1.74）vs. 0.78mm2（+0.20，+0.98），P=0.006]与那些有血管舒张的支架节段相比。
在 ABSORB BVS 装置支架的冠状动脉段中，Ach 引起的血管舒张反应与支架回声强度随时间的降低有关，与 NC 含量低有关。特别是后一种发现类似于未被冠状动脉内装置束缚的天然冠状动脉的行为。
