Ishihara Takayuki, Iida Osamu, Okamoto Shin, Fujita Masashi, Masuda Masaharu, Nanto Kiyonori, Shiraki Tatsuya, Kanda Takashi, Tsujimura Takuya, Okuno Shota, Yanaka Koji, Uematsu Masaaki
Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, 660-8511, Japan.
Cardiovasc Interv Ther. 2017 Oct;32(4):313-317. doi: 10.1007/s12928-016-0411-3. Epub 2016 Jul 18.
Although stent implantation has become widespread for the treatment of patients with peripheral artery disease with femoropopliteal (FP) lesions, in-stent restenosis, especially in-stent occlusion (ISO), remains as a major concern for refractory recurrence. Furthermore, the mechanisms of ISO in FP lesions have not been well elucidated. We performed angioscopy for 6 lesions (bare-metal stent: 3, drug-eluting stent: 3) from 5 patients (mean age 74 ± 10 years, male 40 %) with ISO in the FP artery immediately after wire-passing or thrombus aspiration. The presence of thrombus as well as the presence and location of organic stenosis were evaluated. Median duration from stent implantation to angioscopic evaluation was 1099.5 (514.5-2272.5) days, while the duration from recurrence of symptoms to angioscopic evaluation was 45 (5.75-60) days. Mixed thrombi were observed in all stents. Organic stenosis was detected at the proximal edge of the stents in 5 lesions. Organic stenosis was observed at the overlapping segment of the stent in one lesion. The distal edge of the stents could be evaluated in 3 lesions, and all of them showed organic stenosis at the site. Mixed thrombi and organic stenosis were observed in all stents. Partial development of organic stenosis in a stent followed by thrombus formation may be the potential mechanism of the development of ISO in the FP artery though the sample size of this study was small and it had no serial angioscopic data so that we should consider it as preliminary one at best.
尽管支架植入术已广泛用于治疗患有股腘（FP）病变的外周动脉疾病患者，但支架内再狭窄，尤其是支架内闭塞（ISO），仍然是难治性复发的主要问题。此外，FP病变中ISO的机制尚未得到充分阐明。我们对5例（平均年龄74±10岁，男性40%）患有FP动脉ISO的患者的6个病变（裸金属支架：3个，药物洗脱支架：3个）在通过导丝或血栓抽吸后立即进行了血管镜检查。评估了血栓的存在以及器质性狭窄的存在和位置。从支架植入到血管镜评估的中位时间为1099.5（514.5 - 2272.5）天，而从症状复发到血管镜评估的时间为45（5.75 - 60）天。在所有支架中均观察到混合血栓。在5个病变的支架近端边缘检测到器质性狭窄。在1个病变的支架重叠段观察到器质性狭窄。在3个病变中可以评估支架的远端边缘，并且所有这些病变在该部位均显示器质性狭窄。在所有支架中均观察到混合血栓和器质性狭窄。尽管本研究的样本量较小且没有连续的血管镜数据，以至于我们最多只能将其视为初步研究，但支架内器质性狭窄的部分发展随后形成血栓可能是FP动脉中ISO发生的潜在机制。
