Hashikata Takehiro, Tojo Taiki, Namba Sayaka, Kitasato Lisa, Hashimoto Takuya, Kameda Ryo, Shimohama Takao, Yamaoka-Tojo Minako, Ako Junya
Department of Cardiovascular Medicine, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
Department of Rehabilitation, Kitasato University School of Allied Health Sciences, Sagamihara, Japan.
Heart Vessels. 2016 Feb;31(2):206-11. doi: 10.1007/s00380-014-0598-0. Epub 2014 Nov 2.
Incomplete neointimal coverage and malapposed struts after stenting are associated with increased risk of stent thrombosis. We aimed to evaluate neointimal coverage early after Resolute zotarolimus-eluting stent (R-ZES) implantation using optical coherence tomography (OCT). A total of 20 patients with de novo native coronary lesions with R-ZES were enrolled. Among these patients, 20 stented lesions in 19 patients were evaluated at 1, 2, and 3 months after R-ZES implantation. The strut apposition and neointimal coverage were evaluated by OCT. Neointimal hyperplasia (NIH) thickness and percentage of covered struts and the proportion of incompletely apposed struts were measured at 1-mm intervals. The mean percentages of covered stent struts were over 85 % within 3 months (88.4 ± 6.3 % at 1 month, 95.5 ± 5.5 % at 2 months, 93.6 ± 3.5 % at 3 months). The percentages of incompletely apposed struts were not significantly different among the groups (4.4 ± 4.2 % at 1 month, 1.9 ± 1.9 % at 2 months, 3.1 ± 2.2 % at 3 months, p = 0.51). Mean NIH thickness (38.9 ± 8.1 μm at 1 month, 70.6 ± 18.8 μm at 2 months, 54.1 ± 5.9 at 3 months, p = 0.0016) was thickest in the 2 months group. Most of all OCT findings within 2 months demonstrated neointimal coverage with low signal intensity. The neointimal coverage of ZES-R was over 85 % within 3 months. These data may support shorter requirement of dual antiplatelet therapy duration with R-ZES.
支架置入术后新生内膜覆盖不完全和支架小梁贴壁不良与支架内血栓形成风险增加相关。我们旨在使用光学相干断层扫描（OCT）评估雷帕霉素洗脱支架（R-ZES）植入后早期的新生内膜覆盖情况。共纳入20例新发原发性冠状动脉病变并植入R-ZES的患者。在这些患者中，对19例患者的20个支架植入病变在R-ZES植入后1、2和3个月进行评估。通过OCT评估支架小梁贴壁情况和新生内膜覆盖情况。以1毫米间隔测量新生内膜增生（NIH）厚度、被覆盖支架小梁的百分比以及贴壁不完全支架小梁的比例。3个月内被覆盖支架小梁的平均百分比超过85%（1个月时为88.4±6.3%，2个月时为95.5±5.5%，3个月时为93.6±3.5%）。各组间贴壁不完全支架小梁的百分比无显著差异（1个月时为4.4±4.2%，2个月时为1.9±1.9%，3个月时为3.1±2.2%，p = 0.51）。平均NIH厚度在2个月组最厚（1个月时为38.9±8.1μm，2个月时为70.6±18.8μm，3个月时为54.1±5.9μm，p = 0.0016）。2个月内的大多数OCT检查结果显示新生内膜覆盖且信号强度较低。R-ZES的新生内膜覆盖在3个月内超过85%。这些数据可能支持缩短R-ZES双联抗血小板治疗的持续时间。
