Hu Sining, Wang Chao, Zhe Chunyang, Zhu Yinchun, Yonetsu Taishi, Jia Haibo, Hou Jingbo, Zhang Shaosong, Jang Ik-Kyung, Yu Bo
Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China.
Division of Cardiovascular Medicine, Tsuchiura Kyodo General Hospital, Ibaraki, Japan.
Catheter Cardiovasc Interv. 2017 Mar;89(S1):592-600. doi: 10.1002/ccd.26943.
To compare vascular healing after drug-eluting stent (DES) implantation between plaque rupture (PR) and plaque erosion (PE).
Vascular response after stent implantation in patients with PR has been extensively studied. Little is known about vascular healing after stent implantation in PE.
Sixty-five ACS patients who received optical coherence tomography (OCT) imaging of the culprit lesions both before and after stent implantation at baseline as well as at 6 months were included in this study. Patients were divided into two groups: PR (n = 19) and PE (n = 24). Prestent thrombus burden and poststent intrastent structure (ISS) volume were analyzed during the index procedure. The ratio of uncovered to total stent struts per cross-section score (RUTTS) and neointimal thickness and area were measured at follow-up.
OCT imaging showed that compared with PR, PE showed a significantly lower prestent thrombus score (34.2 ± 19.2 vs. 68.6 ± 44.2, P = 0.009) at baseline and a smaller poststent ISS volume (0.7 ± 0.9 mm vs. 2.1 ± 1.9 mm , P = 0.019). At the 6-month follow-up, PE showed a higher incidence of RUTTS >0.3 (12.2 ± 14.4 vs. 2.0 ± 4.5%, P = 0.003), thinner neointimal thickness (0.05 ± 0.02 mm vs. 0.12 ± 0.08 mm, P = 0.002), and smaller neointimal area (0.5 ± 0.2 vs. 1.2 ± 0.9 mm , P = 0.004) compared with PR. In a multivariate logistic model, PE was identified as an independent predictor for RUTTS >0.3.
PE was associated with less favorable healing following DES implantation when compared to PR at 6 months, indicating longer dual-antiplatelet therapy may be necessary for patients with PE. © 2017 Wiley Periodicals, Inc.
比较药物洗脱支架（DES）植入术后斑块破裂（PR）和斑块侵蚀（PE）患者的血管愈合情况。
PR患者支架植入后的血管反应已得到广泛研究。关于PE患者支架植入后的血管愈合情况知之甚少。
本研究纳入65例急性冠状动脉综合征（ACS）患者，这些患者在基线以及6个月时均接受了罪犯病变支架植入前后的光学相干断层扫描（OCT）成像。患者分为两组：PR组（n = 19）和PE组（n = 24）。在索引手术期间分析术前血栓负荷和术后支架内结构（ISS）体积。随访时测量每个横截面未覆盖支架支柱与总支架支柱的比例（RUTTS）以及新生内膜厚度和面积。
OCT成像显示，与PR组相比，PE组在基线时术前血栓评分显著更低（34.2±19.2对68.6±44.2，P = 0.009），术后ISS体积更小（0.7±0.9 mm对2.1±1.9 mm，P = 0.019）。在6个月随访时，与PR组相比，PE组RUTTS>0.3的发生率更高（12.2±14.4对2.0±4.5%，P = 0.003），新生内膜厚度更薄（0.05±0.02 mm对0.12±0.08 mm，P = 0.002），新生内膜面积更小（0.5±0.2对1.2±0.9 mm，P = 0.004）。在多变量逻辑模型中，PE被确定为RUTTS>0.3的独立预测因素。
与PR组相比，PE组在DES植入后6个月时愈合情况较差，这表明PE患者可能需要更长时间的双联抗血小板治疗。©2017威利期刊公司
