Kawai Kenji, Ichikawa Minoru, Masuyama Tohru, Kijima Yoshiyuki
Department of Cardiology, Higahi-osaka City General Hospital, 3-4-5 Nishi Iwata, Higashi-osaka, Osaka 578-8588, Japan; Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
Department of Cardiology, Higahi-osaka City General Hospital, 3-4-5 Nishi Iwata, Higashi-osaka, Osaka 578-8588, Japan.
Int J Cardiol. 2016 Oct 15;221:855-8. doi: 10.1016/j.ijcard.2016.07.089. Epub 2016 Jul 5.
Arterial repair after intracoronary stenting depends on stent types and plaque vulnerability. The aim of this study was angioscopic comparison of arterial repair after implantation of the second-generation drug-eluting stents (G2-DES) between the stable and vulnerable plaques.
Four types of G2-DES were successfully implanted into stable plaques (n=41) and vulnerable plaques (n=34): 13 and 9 Xience-everolimus-, 7 and 6 Endeavor-zotarolimus-, 15 and 9 Resolute-zotarolimus-, and 6 and 10 Nobori-biolimus-eluting stents (EES, E-ZES, R-ZES, and BES), respectively. Coronary angioscopy at 1-year follow-up revealed in-stent appearance, such as neointimal stent coverage (NSC), presence of yellow plaques (YP), and in-stent mural thrombus (MT). NSC was graded into poor and good coverage.
Yellow plaques and mural thrombi were found more frequently in the vulnerable plaques than in the stable plaques (29% vs. 12%, P=0.06; 12 vs. 0%, P=0.02; respectively). In EES, poor NSC was observed more frequently in the vulnerable plaques than in the stable plaques (54% vs. 11%, P=0.04). In BES, YP was observed more frequently in the vulnerable plaques than in the stable plaques (80% vs. 17%, P=0.01). In E-ZES and R-ZES, there were no significant differences with regards to angioscopic parameters between the stable and vulnerable plaques.
Arterial repair after EES and BES implantation into the vulnerable plaques remained vulnerable even at 1-year follow-up.
冠状动脉内支架置入术后的动脉修复取决于支架类型和斑块易损性。本研究的目的是通过血管内镜比较第二代药物洗脱支架（G2-DES）植入后稳定斑块和易损斑块的动脉修复情况。
将四种类型的G2-DES成功植入稳定斑块（n = 41）和易损斑块（n = 34）中：分别为13枚和9枚Xience依维莫司洗脱支架、7枚和6枚Endeavor佐他莫司洗脱支架、15枚和9枚Resolute佐他莫司洗脱支架以及6枚和10枚Nobori生物素洗脱支架（EES、E-ZES、R-ZES和BES）。1年随访时的冠状动脉血管内镜检查显示了支架内表现，如新生内膜支架覆盖情况（NSC）、黄色斑块的存在情况以及支架内壁血栓（MT）。NSC分为覆盖差和覆盖好。
易损斑块中黄色斑块和壁血栓的发现频率高于稳定斑块（分别为29%对12%，P = 0.06；12对0%，P = 0.02）。在EES中，易损斑块中观察到覆盖差的NSC的频率高于稳定斑块（54%对11%，P = 0.04）。在BES中，易损斑块中观察到黄色斑块的频率高于稳定斑块（80%对17%，P = 0.01）。在E-ZES和R-ZES中，稳定斑块和易损斑块在血管内镜参数方面无显著差异。
即使在1年随访时，将EES和BES植入易损斑块后的动脉修复仍保持易损状态。
