Gomez-Lara Josep, Salvatella Neus, Gonzalo Nieves, Hernández-Hernández Felipe, Fernandez-Nofrerias Eduard, Sánchez-Recalde Angel, Bastante Teresa, Marcano Ana, Romaguera Rafael, Ferreiro José-Luis, Roura Gerard, Teruel Luis, Ariza-Solé Albert, Miranda-Guardiola Faustino, Rodríguez García-Abad Vera, Gomez-Hospital Joan-Antoni, Alfonso Fernando, Cequier Angel
Hospital Universitari de Bellvitge, Institut d'Investigació Biomèdica de Bellvitge (IDIBELL), Universitat de Barcelona, L'Hospitalet de Llobregat, Spain.
EuroIntervention. 2016 Dec 10;12(11):e1355-e1365. doi: 10.4244/EIJY15M12_08.
Our aim was to describe the intravascular ultrasound (IVUS) findings of patients with late stent thrombosis (ST) undergoing percutaneous intervention, and to compare the pre- and post-intervention IVUS findings of patients treated with balloon angioplasty (BA) vs. additional stent implantation (ASI).
A total of 117 patients with late ST imaged with IVUS were included (51.2% had drug-eluting stent ST). Treatment was left to the operator's discretion: BA was performed in 53.8% and ASI in 46.2%. Pre-intervention, incomplete stent apposition (ISA) was observed in 69.8% vs. 63.0% (p=0.43), underexpansion in 33.3% vs. 18.5% (p=0.07) and restenosis in 15.9% vs. 27.8% (p=0.12), respectively. Post-intervention, persistent ISA was observed in 37.2% vs. 60.9% (p=0.03) and malapposition volume decreased by 43.6% vs. 2.6% (p=0.03). Persistent underexpansion was observed in 9.3% vs. 17.4% (p=0.26); however, the stent expansion index was largely increased with BA (from 0.75 to 0.88) compared to ASI (from 0.80 to 0.82); p=0.046. At two years, recurrent ST was observed in one (1.7%) vs. four (7.7%) patients, respectively; p=0.09.
Non-optimal IVUS criteria of stent implantation are often observed in patients with late ST. Treatment of late ST with BA leads to a larger reduction of malapposition and underexpansion with respect to ASI and is associated with favourable outcomes.
我们的目的是描述接受经皮介入治疗的晚期支架血栓形成（ST）患者的血管内超声（IVUS）检查结果，并比较接受球囊血管成形术（BA）与额外支架植入术（ASI）治疗的患者介入前后的IVUS检查结果。
总共纳入了117例接受IVUS成像的晚期ST患者（51.2%为药物洗脱支架ST）。治疗由操作者自行决定：53.8%的患者接受了BA，46.2%的患者接受了ASI。介入前，分别有69.8%和63.0%的患者观察到支架贴壁不全（ISA）（p=0.43），33.3%和18.5%的患者观察到扩张不足（p=0.07），15.9%和27.8%的患者观察到再狭窄（p=0.12）。介入后，分别有37.2%和60.9%的患者观察到持续性ISA（p=0.03），贴壁不良体积分别减少了43.6%和2.6%（p=0.03）。分别有9.3%和17.4%的患者观察到持续性扩张不足（p=0.26）；然而，与ASI（从0.80增至0.82）相比，BA使支架扩张指数大幅增加（从0.75增至0.88）；p=0.046。两年时，分别有1例（1.7%）和4例（7.7%）患者观察到复发性ST；p=0.09。
晚期ST患者常观察到支架植入的IVUS标准不理想。与ASI相比，用BA治疗晚期ST可使贴壁不良和扩张不足得到更大程度的减轻，并与良好的预后相关。
