Harrington Heart and Vascular Institute, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio; Department of Cardiology, New Tokyo Hospital, Chiba, Japan.
JACC Cardiovasc Interv. 2013 Oct;6(10):1035-45. doi: 10.1016/j.jcin.2013.05.015.
This study sought to assess stent-vessel interactions after drug-eluting stent (DES) implantation in unprotected left main coronary artery (ULM) by frequency-domain optical coherence tomography (FD-OCT).
Percutaneous coronary intervention using DES in ULM has been increasingly performed in routine practice. Recently, FD-OCT assessments of DES-vessel interactions have been used as surrogates for DES safety; however, there are no FD-OCT studies in ULM.
We prospectively enrolled 33 consecutive patients with ULM disease treated with sirolimus- (n = 11) and everolimus-eluting stents (n = 22). FD-OCT assessments were performed post-percutaneous coronary intervention and at 9-month follow-up. Three different segments of ULM were compared: distal (DIS), bifurcation (BIF), and ostial-body (BODY). The primary endpoints were percentages of uncovered and malapposed struts at 9-month follow-up, and the secondary endpoint was neointimal hyperplasia area.
We analyzed 25,873 stent struts. Significant differences were demonstrated for percentage of uncovered struts (3.4%, 11.7%, and 18.7%, respectively for DIS, BIF, and BODY; p < 0.05 for all the comparisons). Malapposition was also more common in BODY (5.3%) than in DIS (0.6%) and BIF (2.0%) segments (p < 0.05 for BODY vs. DIS, and BODY vs. BIF). Equivalent neointimal hyperplasia areas were demonstrated in all segments. Acute malapposition rates led to different patterns of DES-vessel interactions at 9-month follow-up.
Distinct patterns of DES-vessel interactions were demonstrated in different segments of ULM. Acute stent strut malapposition affects these findings.
本研究旨在通过频域光相干断层扫描（FD-OCT）评估无保护左主干冠状动脉（ULM）内药物洗脱支架（DES）植入后的支架-血管相互作用。
在常规实践中，越来越多地在 ULM 中使用 DES 进行经皮冠状动脉介入治疗。最近，DES 血管相互作用的 FD-OCT 评估已被用作 DES 安全性的替代指标；然而，在 ULM 中尚无 FD-OCT 研究。
我们前瞻性纳入 33 例接受西罗莫司（n = 11）和依维莫司洗脱支架（n = 22）治疗的 ULM 疾病连续患者。在经皮冠状动脉介入治疗后和 9 个月随访时进行 FD-OCT 评估。比较 ULM 的三个不同节段：远端（DIS）、分叉（BIF）和开口体部（BODY）。主要终点是 9 个月随访时未覆盖和贴壁不良支架的百分比，次要终点是新生内膜增生面积。
我们分析了 25873 个支架支架。DIS、BIF 和 BODY 段的未覆盖支架百分比分别为 3.4%、11.7%和 18.7%（所有比较均 p < 0.05），差异有统计学意义。BIF（2.0%）节段（BODY 与 DIS 比较，p < 0.05；BODY 与 BIF 比较，p < 0.05）也更常见。所有节段均显示等效的新生内膜增生面积。急性贴壁不良率导致 9 个月随访时 DES-血管相互作用呈现不同模式。
在 ULM 的不同节段表现出不同的 DES-血管相互作用模式。急性支架支架贴壁不良会影响这些发现。
