Andreou Ioannis, Takahashi Saeko, Tsuda Masaya, Shishido Koki, Antoniadis Antonios P, Papafaklis Michail I, Mizuno Shingo, Coskun Ahmet U, Saito Shigeru, Feldman Charles L, Edelman Elazer R, Stone Peter H
Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA.
Department of Cardiovascular Medicine, Shonan Kamakura General Hospital, Kanagawa, Japan.
Atherosclerosis. 2016 Sep;252:9-14. doi: 10.1016/j.atherosclerosis.2016.07.914. Epub 2016 Jul 22.
The natural history and the role of atherosclerotic plaque located behind the stent (PBS) are still poorly understood. We evaluated the serial changes in PBS following bare-metal (BMS) compared to first-generation drug-eluting stent (DES) implantation and the impact of these changes on in-stent neointimal hyperplasia (NIH).
Three-dimensional coronary reconstruction by angiography and intravascular ultrasound was performed after intervention and at 6-10-month follow-up in 157 patients with 188 lesions treated with BMS (n = 89) and DES (n = 99).
There was a significant decrease in PBS area (-7.2%; p < 0.001) and vessel area (-1.7%; p < 0.001) after BMS and a respective increase in both areas after DES implantation (6.1%; p < 0.001 and 4.1%; p < 0.001, respectively). The decrease in PBS area significantly predicted neointimal area at follow-up after BMS (β: 0.15; 95% confidence interval [CI]: 0.10-0.20, p < 0.001) and DES (β: 0.09; 95% CI: 0.07-0.11; p < 0.001) implantation. The decrease in PBS area was the most powerful predictor of significant NIH after BMS implantation (odds ratio: 1.13; 95% CI: 1.02-1.26; p = 0.02).
The decrease in PBS area after stent implantation is significantly associated with the magnitude of NIH development at follow-up. This finding raises the possibility of a communication between the lesion within the stent and the underlying native atherosclerotic plaque, and may have important implications regarding the pathobiology of in-stent restenosis and late/very late stent thrombosis.
支架后置动脉粥样硬化斑块（PBS）的自然病程及其作用仍未完全明确。我们评估了裸金属支架（BMS）与第一代药物洗脱支架（DES）植入后PBS的系列变化，以及这些变化对支架内新生内膜增生（NIH）的影响。
对157例患者的188处病变进行了介入治疗，术后及6至10个月随访时通过血管造影和血管内超声进行三维冠状动脉重建，其中89例患者植入BMS，99例患者植入DES。
BMS植入后PBS面积（-7.2%；p<0.001）和血管面积（-1.7%；p<0.001）显著减小，DES植入后这两个面积均相应增加（分别为6.1%；p<0.001和4.1%；p<0.001）。BMS（β：0.15；95%置信区间[CI]：0.10 - 0.20，p<0.001）和DES（β：0.09；95%CI：0.07 - 0.11；p<0.001）植入后，PBS面积的减小显著预测了随访时的新生内膜面积。PBS面积的减小是BMS植入后显著NIH的最有力预测因素（优势比：1.13；95%CI：1.02 - 1.26；p = 0.02）。
支架植入后PBS面积的减小与随访时NIH发展的程度显著相关。这一发现增加了支架内病变与潜在的原生动脉粥样硬化斑块之间存在联系的可能性，并且可能对支架内再狭窄和晚期/极晚期支架血栓形成的病理生物学具有重要意义。
