Nasu Kenya, Oikawa Yuji, Aizawa Tadanori, Suzuki Takahiko
Department of Cardiology, Toyohashi Heart Center, Aichi, Japan.
Department of Cardiology, The Cardiovascular Institute, Tokyo, Japan.
Int J Cardiol Heart Vessel. 2014 Feb 8;3:21-27. doi: 10.1016/j.ijchv.2014.01.001. eCollection 2014 Jun.
Previous clinical trials have demonstrated the clinical and angiographic superiority of everolimus-eluting stents (EES) compared with paclitaxel-eluting stents (PES) in the small coronary vessel. However, the differences of vascular response including assessment of morphological neointimal tissue (NIT) characteristics using optical coherence tomography (OCT) have not been fully evaluated. The aim of this study is to evaluate the differences of chronic vascular response following small coronary stenting between EES and PES using OCT.
A prospective OCT examination at 9 month follow-up was performed for 50 small coronary artery diseases (50 patients) treated by a single 2.5 mm stent for each stent group. Cross-sectional area within stent segments were analyzed at an interval of 1 mm. NIT structure (homogeneous or heterogeneous) was evaluated for qualitative assessment. Homogeneous NIT was observed significantly higher and heterogeneous NIT was lower in EES compared with PES (93% vs. 89%; p = 0.003, 6.5% vs. 10.3%; p = 0.002, respectively). The frequencies of exposed and malapposed struts were lower in EES compared with PES (0.2% vs. 1.7%; p = 0.0001, 0.1% vs. 0.3%; p = 0.001, respectively). NIT eccentricity index and NIT area were lower in EES compared with PES (0.69 ± 0.08 vs. 0.76 ± 0.10; p = 0.001, 0.97 ± 0.42 mm vs. 1.27 ± 0.67 mm; p = 0.01, respectively).
A favorable vascular response was observed after EES implantation compared with PES for small coronary artery disease. In addition, the characteristics of NIT after EES implantation were more stable than PES at 9 month follow-up.
既往临床试验已证明，在小冠状动脉血管中，依维莫司洗脱支架（EES）在临床和血管造影方面优于紫杉醇洗脱支架（PES）。然而，包括使用光学相干断层扫描（OCT）评估形态学新生内膜组织（NIT）特征在内的血管反应差异尚未得到充分评估。本研究的目的是使用OCT评估EES和PES在小冠状动脉支架置入术后慢性血管反应的差异。
对每个支架组中接受单个2.5mm支架治疗的50例小冠状动脉疾病患者（共50例）进行了9个月随访时的前瞻性OCT检查。以1mm的间隔分析支架节段内的横截面积。对NIT结构（均匀或不均匀）进行定性评估。与PES相比，EES中观察到均匀NIT的比例显著更高，不均匀NIT的比例更低（分别为93%对89%；p = 0.003，6.5%对10.3%；p = 0.002）。与PES相比，EES中暴露和贴壁不良支架的频率更低（分别为0.2%对1.7%；p = 0.0001，0.1%对0.3%；p = 0.001）。与PES相比，EES的NIT偏心指数和NIT面积更低（分别为0.69±0.08对0.76±0.10；p = 0.001，0.97±0.42mm对1.27±0.67mm；p = 0.01）。
对于小冠状动脉疾病，与PES相比，EES植入后观察到了良好的血管反应。此外，在9个月随访时，EES植入后NIT的特征比PES更稳定。
