使用光学相干断层扫描和虚拟组织学血管内超声对植入裸金属支架和药物洗脱支架3年以上、内膜增生程度为轻度至中度的患者进行支架内组织评估。

Intra-stent tissue evaluation within bare metal and drug-eluting stents > 3 years since implantation in patients with mild to moderate neointimal proliferation using optical coherence tomography and virtual histology intravascular ultrasound.

作者信息

Kitabata Hironori, Loh Joshua P, Pendyala Lakshmana K, Omar Alfazir, Ota Hideaki, Minha Sa'ar, Magalhaes Marco A, Torguson Rebecca, Chen Fang, Satler Lowell F, Pichard Augusto D, Waksman Ron

机构信息

Division of Cardiology, MedStar Washington Hospital Center, Washington, DC.

出版信息

Cardiovasc Revasc Med. 2014 Apr;15(3):149-55. doi: 10.1016/j.carrev.2014.01.009. Epub 2014 Jan 20.

DOI:10.1016/j.carrev.2014.01.009

PMID:24767313

Abstract

OBJECTIVE

We aimed to compare neointimal tissue characteristics between bare-metal stents (BMS) and drug-eluting stents (DES) at long-term follow-up using optical coherence tomography (OCT) and virtual histology intravascular ultrasound (VH-IVUS).

BACKGROUND

Neoatherosclerosis in neointima has been reported in BMS and in DES.

METHODS

Thirty patients with 36 stented lesions [BMS (n=17) or DES (n=19)] >3years after implantation were prospectively enrolled. OCT and VH-IVUS were performed and analyzed independently. Stents with ≥70% diameter stenosis were excluded.

RESULTS

The median duration from implantation was 126.0months in the BMS group and 60.0months in the DES group (p <0.001). Lipid-laden intima (58.8% vs. 42.1%, p=0.317), thrombus (17.6% vs. 5.3%, p=0.326), and calcification (35.3% vs. 26.3%, p=0.559) did not show significant differences between BMS and DES. When divided into 3 time periods, the cumulative incidence of lipid-laden neointima from >3years to <9years was similar between BMS and DES (42.9% vs. 42.1%, p=1.000). Furthermore, it continued to gradually increase over time in both groups. OCT-derived thin-cap fibroatheroma (TCFA) was observed in 17.6% of BMS- and 5.3% of DES-treated lesions (p=0.326). No stents had evidence of intimal disruption. The percentage volume of necrotic core (16.1% [9.7, 20.3] vs. 9.7% [7.0, 16.5], p=0.062) and dense calcium (9.5% [3.8, 13.6] vs. 2.7% [0.4, 4.9], p=0.080) in neointima tended to be greater in BMS-treated lesions. Intra-stent VH-TCFA (BMS vs. DES 45.5% vs. 18.2%, p=0.361) did not differ significantly.

CONCLUSION

At long-term follow-up beyond 3 years after implantation, the intra-stent neointimal tissue characteristics appeared similar for both BMS and DES.

摘要

目的

我们旨在通过光学相干断层扫描（OCT）和虚拟组织学血管内超声（VH-IVUS）对裸金属支架（BMS）和药物洗脱支架（DES）进行长期随访，比较两者新生内膜组织特征。

背景

BMS和DES中均有新生内膜出现新动脉粥样硬化的报道。

方法

前瞻性纳入30例植入支架病变超过3年的患者（共36处支架病变，其中BMS组17处，DES组19处）。独立进行OCT和VH-IVUS检查并分析。排除直径狭窄≥70%的支架。

结果

BMS组植入后的中位时间为126.0个月，DES组为60.0个月（p<0.001）。BMS和DES之间，富含脂质内膜（58.8%对42.1%，p=0.317）、血栓（17.6%对5.3%，p=0.326）和钙化（35.3%对26.3%，p=0.559）均无显著差异。分为3个时间段后，BMS和DES从>3年至<9年富含脂质新生内膜的累积发生率相似（42.9%对42.1%，p=1.000）。此外，两组中该发生率均随时间逐渐增加。在BMS治疗病变中观察到17.6%有OCT衍生的薄帽纤维粥样斑块（TCFA），DES治疗病变中为5.3%（p=0.326）。无支架有内膜破裂的证据。BMS治疗病变新生内膜中坏死核心的体积百分比（16.1%[9.7,20.3]对9.7%[7.0,16.5]，p=0.062）和致密钙的体积百分比（9.5%[3.8,13.6]对2.7%[0.4,4.9]，p=0.080）倾向于更高。支架内VH-TCFA（BMS对DES为45.5%对18.2%，p=0.361）无显著差异。