使用频域光学相干断层扫描评估的支架内再狭窄显示第二代药物洗脱支架中冠状动脉愈合过程顺利。
In-stent restenosis assessed with frequency domain optical coherence tomography shows smooth coronary arterial healing process in second-generation drug-eluting stents.
作者信息
Kajiya Takashi, Yamaguchi Hiroshi, Takaoka Junichiro, Fukunaga Kengo, Arima Ryoichi, Miyamura Akihiro, Ninomiya Toshiko, Atsuchi Nobuhiko, Atsuchi Yoshihiko, Terashima Mitsuyasu, Kaneda Hideaki, Ohishi Mitsuru
机构信息
Department of Cardiology, Tenyoukai Central Hospital, Kagoshima, Japan.
Yamaguchi Hiroshi Clinic, Kagoshima, Japan.
出版信息
Singapore Med J. 2019 Jan;60(1):48-51. doi: 10.11622/smedj.2018038. Epub 2018 Apr 10.
INTRODUCTION
The pathophysiology and mechanism of in-stent restenosis (ISR) after implantation of second-generation drug-eluting stents (DESs) are not fully clear. We compared the morphological characteristics of ISR between first- and second-generation DESs using frequency domain optical coherence tomography (OCT).
METHODS
Patients who underwent follow-up coronary angiography (CAG) after first-generation (CYPHER™ and TAXUS™) and second-generation (Nobori®, PROMUS Element™, Resolute Integrity and XIENCE) DES implantations were examined. ISR was defined as lesions of over 50% diameter stenosis at follow-up CAG. Frequency domain OCT was performed at the time of revascularisation of ISR. Tissue morphology was assessed at minimum lumen area. OCT images of DESs at both early (≤ 1 year) and late (> 1 year) phase follow-up were compared.
RESULTS
On qualitative OCT assessment, the ratios of homogeneous, layered, heterogeneous without-attenuation and heterogeneous with-attenuation morphologies were 57.1%, 17.1%, 20.0% and 5.7%, respectively, for second-generation DES ISR (n = 35), and 16.7%, 25.0%, 25.0% and 33.3%, respectively, for first-generation DES ISR (n = 36). At late phase follow-up, homogeneous morphology was significantly more common for second-generation DES ISR compared to first-generation DES ISR (first-generation: 8.0% vs. second-generation: 50.0%; p < 0.01) while heterogeneous with-attenuation morphology was significantly more common for first-generation DES ISR (first-generation: 44.0% vs. second-generation: 5.6%; p < 0.01).
CONCLUSION
Homogeneous tissue morphology was more frequently found for second-generation than first-generation DES ISR, especially in the late phase. This suggested that neointimal hyperplasia was the main mechanism in second-generation DES ISR, and that the neointima was stabilised, much like in bare metal stent implantation.
引言
第二代药物洗脱支架（DES）植入后支架内再狭窄（ISR）的病理生理学和机制尚未完全明确。我们使用频域光学相干断层扫描（OCT）比较了第一代和第二代DES之间ISR的形态学特征。
方法
对接受第一代（CYPHER™和TAXUS™）和第二代（Nobori®、PROMUS Element™、Resolute Integrity和XIENCE）DES植入后进行随访冠状动脉造影（CAG）的患者进行检查。ISR定义为随访CAG时直径狭窄超过50%的病变。在ISR血管重建时进行频域OCT检查。在最小管腔面积处评估组织形态。比较早期（≤1年）和晚期（>1年）随访时DES的OCT图像。
结果
在定性OCT评估中，第二代DES ISR（n = 35）的均匀、分层、无衰减异质性和有衰减异质性形态的比例分别为57.1%、17.1%、20.0%和5.7%，第一代DES ISR（n = 36）分别为16.7%、25.0%、25.0%和33.3%。在晚期随访时，与第一代DES ISR相比，第二代DES ISR的均匀形态明显更常见（第一代：8.0% vs. 第二代：50.0%；p < 0.01），而第一代DES ISR的有衰减异质性形态明显更常见（第一代：44.0% vs. 第二代：5.6%；p < 0.01）。
结论
第二代DES ISR比第一代更常出现均匀的组织形态，尤其是在晚期。这表明新生内膜增生是第二代DES ISR的主要机制，并且新生内膜已稳定，很像裸金属支架植入时的情况。
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