Cardiovascular Research Foundation, New York, NY, USA.
EuroIntervention. 2017 Jun 20;13(3):294-302. doi: 10.4244/EIJ-D-16-00787.
In-stent restenosis (ISR) is an important cause of drug-eluting stent (DES) failure and target vessel revascularisation. In this study we aimed to evaluate differences between early and late-presenting restenosis in second-generation DES using optical coherence tomography (OCT).
Overall, 171 cases of second-generation DES ISR with a follow-up OCT minimum lumen area <3.0 mm2 were included: 33.3% of patients (n=57) had early ISR, and 66.7% (n=114) had late ISR (duration from stent implantation >1 year). Minimum stent area (MSA) <4.0 mm2, neointimal thickness <100 µm, and heterogeneous neointimal hyperplasia (NIH) were more prevalent in early ISR, whereas NIH with neoatherosclerosis trended towards being more frequent for late ISR (28.9% vs. 15.8%, p=0.06). Multivariable analysis revealed that duration from implantation >2 years, absence of statin use, and NIH >50% were independent predictors for neoatherosclerosis (all p<0.05).
OCT morphological characteristics of second-generation DES ISR differ between early and late presentation. Early ISR was associated with MSA <4.0 mm2, while neoatherosclerosis contributed more commonly to late ISR.
支架内再狭窄（ISR）是药物洗脱支架（DES）失败和靶血管血运重建的重要原因。本研究旨在通过光学相干断层扫描（OCT）评估第二代 DES 中早期和晚期再狭窄的差异。
共纳入 171 例第二代 DES-ISR 患者，随访 OCT 最小管腔面积<3.0mm2：33.3%（n=57）的患者为早期 ISR，66.7%（n=114）为晚期 ISR（支架植入后>1 年）。早期 ISR 中最小支架面积（MSA）<4.0mm2、新生内膜厚度<100µm 和不均匀性新生内膜增生（NIH）更为常见，而晚期 ISR 中伴有新生动脉粥样硬化的 NIH 更为常见（28.9%比 15.8%，p=0.06）。多变量分析显示，植入后>2 年、无他汀类药物使用和 NIH>50%是新生动脉粥样硬化的独立预测因素（均 p<0.05）。
第二代 DES-ISR 的 OCT 形态学特征在早期和晚期表现不同。早期 ISR 与 MSA<4.0mm2 相关，而晚期 ISR 中更常见的是新生动脉粥样硬化。
