Ansel Gary M, Jaff Michael R, Popma Jeffrey J, Battisti Anthony J, Lottes Aaron E, Harnish Paul, Dake Michael D
1 Department of Internal Medicine, OhioHealth/Riverside Methodist Hospital, Columbus, OH, USA.
2 Department of Medicine, Harvard Medical School, Boston, MA, USA.
J Endovasc Ther. 2017 Aug;24(4):499-503. doi: 10.1177/1526602817708778. Epub 2017 May 9.
To evaluate the patterns of in-stent restenosis (ISR) within femoropopliteal bare metal stents (BMS) and drug-eluting stents (DES) as determined by quantitative angiographic analysis.
Utilizing results from independent core laboratory angiographic imaging analysis, quantitative assessment of the restenotic tissue burden was evaluated in 33 patients with symptomatic femoropopliteal ISR, including 20 lesions in 19 patients (mean age 71.5±8.1 years; 11 men) treated with DES and 14 lesions in 14 patients (mean age 70.6±9.2 years; 9 men) treated with BMS.
The average time to target lesion revascularization was similar (8.7 months) for the DES and BMS groups. The DES group had significantly less recurrent disease burden (17.1%) compared with the BMS group (27.8%, p=0.03), representing a 39% relative reduction.
Reduced restenotic tissue after endovascular intervention is associated with improved hemodynamics and fewer clinical symptoms and may explain the reduced need for reintervention in restenotic lesions initially treated with DES as compared with BMS. Further study of treatment failure modes may lead to improved device selection criteria to treat patients with peripheral artery disease.
通过定量血管造影分析评估股腘动脉裸金属支架（BMS）和药物洗脱支架（DES）内支架内再狭窄（ISR）的模式。
利用独立核心实验室血管造影成像分析结果，对33例有症状的股腘动脉ISR患者的再狭窄组织负荷进行定量评估，其中包括19例患者的20处病变（平均年龄71.5±8.1岁；11名男性）接受DES治疗，以及14例患者的14处病变（平均年龄70.6±9.2岁；9名男性）接受BMS治疗。
DES组和BMS组达到靶病变血管重建的平均时间相似（8.7个月）。与BMS组（27.8%，p=0.03）相比，DES组的复发疾病负担显著更低（17.1%），相对降低了39%。
血管内介入治疗后再狭窄组织减少与血流动力学改善及临床症状减少相关，这可能解释了与BMS相比，最初接受DES治疗的再狭窄病变再次干预需求减少的原因。对治疗失败模式的进一步研究可能会导致改进治疗外周动脉疾病患者的器械选择标准。
