Inaba Shinji, Mintz Gary S, Yun Kyeong Ho, Yakushiji Tadayuki, Shimizu Takehisa, Kang Soo-Jin, Généreux Philippe, Weisz Giora, Rabbani Leroy E, Moses Jeffrey W, Stone Gregg W, Maehara Akiko
Cardiovascular Research Foundation, New York, NY, USA.
EuroIntervention. 2014 Mar 20;9(11):1301-8. doi: 10.4244/EIJV9I11A220.
Mechanical complications contribute to bare metal and first-generation drug-eluting stent (DES) failure. However, the importance of the mechanical complications of second-generation DES remains unclear. We report mechanical complications associated with everolimus-eluting stent (EES) failures.
We retrospectively analysed 177 consecutive EES-treated lesions in 136 patients who underwent intravascular ultrasound (IVUS) at follow-up. Mechanical complications were identified in 17 patients (five stable angina, 10 unstable angina, two non-ST-elevation myocardial infarction [NSTEMI] without angiographic thrombus). Fifteen (88.2%) were treated with repeat revascularisation. By IVUS, there were 16 focal (94.1%) and one diffuse (5.9%) in-stent restenoses. Complete stent fracture with separation was seen in only one, partial stent fracture with separation was seen in three, and in 13 there was longitudinal deformation (n=2) or stent strut fracture (n=11) with overlapping of the proximal and distal stent fragments. In 13 EES with evidence of overlapping in the setting of either fracture or deformation, there was a 35.5±12.2% smaller stent area compared to the adjacent proximal and distal stent fragments, and >50% neointimal hyperplasia in 12 (92.3%).
We found EES mechanical complications, often followed by longitudinal deformation or fracture leading to excessive neointimal hyperplasia, in-stent restenosis, and repeat revascularisation.
机械性并发症是导致裸金属支架和第一代药物洗脱支架（DES）失效的原因之一。然而，第二代DES机械性并发症的重要性仍不明确。我们报告了与依维莫司洗脱支架（EES）失效相关的机械性并发症。
我们回顾性分析了136例接受EES治疗的连续病变患者，这些患者在随访时接受了血管内超声（IVUS）检查。17例患者出现机械性并发症（5例稳定型心绞痛、10例不稳定型心绞痛、2例非ST段抬高型心肌梗死[NSTEMI]且无血管造影血栓形成）。15例（88.2%）接受了再次血运重建治疗。通过IVUS检查，发现16处局灶性（94.1%）和1处弥漫性（5.9%）支架内再狭窄。仅见1例完全性支架断裂分离，3例部分性支架断裂分离，13例出现纵向变形（n = 2）或支架支柱断裂（n = 11），近端和远端支架碎片重叠。在13例有断裂或变形且存在重叠证据的EES中，与相邻近端和远端支架碎片相比，支架面积小35.5±12.2%，12例（92.3%）新生内膜增生>50%。
我们发现EES存在机械性并发症，常继发纵向变形或断裂，导致过度的新生内膜增生、支架内再狭窄和再次血运重建。
