Blachutzik Florian, Boeder Niklas, Wiebe Jens, Mattesini Alessio, Dörr Oliver, Most Astrid, Bauer Timm, Tröbs Monique, Röther Jens, Schlundt Christian, Achenbach Stephan, Hamm Christian, Nef Holger
Friedrich-Alexander Universität Erlangen-Nürnberg (FAU), Department of Medicine 2-Cardiology, University Hospital Erlangen, Ulmenweg 18, 91054, Erlangen, Germany.
Justus Liebig Universität Giessen, University Hospital Giessen, Medical Clinic I, Giessen, Germany.
Heart Vessels. 2017 Jul;32(7):781-789. doi: 10.1007/s00380-016-0932-9. Epub 2016 Dec 21.
Overlapping implantation of bioresorbable vascular scaffolds is frequently necessary, but its influence on vessel and scaffold structure has not been thoroughly analyzed previously. The aim of this study was to analyze the acute effects of overlapping implantation on BRS as determined by optical coherence tomography (OCT). A total of 38 patients with de novo coronary artery stenoses who underwent OCT in the context of implantation of novolimus-eluting BRS (DESolve, Elixir Medical Corporation, Sunnyvale, California, USA) were investigated. In 15 patients, overlapping implantation of two BRS was performed, while 23 patients with implantation of one single BRS served as the control group. OCT data were retrospectively analyzed regarding acute scaffold implantation results. There were no significant differences between the overlap and control group in terms of residual in-scaffold area stenosis, scaffold area, mean or minimal lumen area, eccentricity index, incomplete scaffold apposition area or malapposition. While strut fracture was slightly more frequent in BRS with overlap its incidence was low overall. In patients with overlapping BRS, overlap segments did not display smaller lumen areas than segments without overlap (mean lumen area overlap: 8.16 ± 2.97 mm vs. no overlap: 7.70 ± 2.55 mm; p = 0.71; minimal lumen area overlap: 6.83 ± 2.71 mm vs. no overlap: 6.17 ± 2.58 mm; p = 0.37). Acute mechanical performance of novolimus-eluting BRS is not impaired by overlapping implantation. It can be assumed that vessel expansion compensates for the double scaffold layer in the overlap area resulting in a similar lumen area in overlap areas and in those with a single strut layer.
生物可吸收血管支架的重叠植入常常是必要的，但此前其对血管和支架结构的影响尚未得到充分分析。本研究的目的是通过光学相干断层扫描（OCT）分析重叠植入对生物可吸收血管支架的急性影响。共调查了38例在植入诺伐他汀洗脱生物可吸收血管支架（DESolve，Elixir Medical Corporation，美国加利福尼亚州桑尼维尔）时接受OCT检查的初发冠状动脉狭窄患者。15例患者进行了两个生物可吸收血管支架的重叠植入，而23例植入单个生物可吸收血管支架的患者作为对照组。对OCT数据进行回顾性分析以了解急性支架植入结果。重叠组和对照组在支架内残余面积狭窄、支架面积、平均或最小管腔面积、偏心指数、支架贴壁不全面积或贴壁不良方面无显著差异。虽然重叠的生物可吸收血管支架中支柱骨折略为常见，但其总体发生率较低。在重叠生物可吸收血管支架的患者中，重叠节段的管腔面积并不小于无重叠节段（平均管腔面积重叠：8.16±2.97mm vs无重叠：7.70±2.55mm；p = 0.71；最小管腔面积重叠：6.83±2.71mm vs无重叠：6.17±2.58mm；p = 0.37）。诺伐他汀洗脱生物可吸收血管支架的急性机械性能不会因重叠植入而受损。可以推测，血管扩张可补偿重叠区域的双层支架，从而使重叠区域和单支柱层区域的管腔面积相似。
