Kawai Kenji, Ichikawa Minoru, Masuyama Tohru, Ishihara Masaharu, Kijima Yoshiyuki
Department of Cardiology, Higashi-osaka City Medical Center, 3-4-5 Nishi Iwata, Higashi-osaka, Osaka 578-8588, Japan.
Division of Cardiovascular Medicine and Coronary Heart Disease, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo 663-8501, Japan.
Int J Cardiol Heart Vasc. 2018 May 25;19:83-87. doi: 10.1016/j.ijcha.2018.05.004. eCollection 2018 Jun.
The purpose of this study is to elucidate the impact of out-stent plaque characteristics on vascular response after implantation of second generation drug-eluting stent (G2-DES).
Enrolled were 37 patients with 39 coronary artery lesions into which three types of G2-DES were successfully implanted (9 Nobori biolimus-, BES; 15 Xience everolimus-, EES; 15 Resolute zotarolimus-eluting stents; R-ZES). Immediately after (baseline) and one year after the implantation (follow-up), iMAP-intravascular ultrasound (IVUS) was performed to measure out-stent plaque volume (OSPV) and its components. Percent OSPV and vulnerable plaque index (VPI) were defined as percentile of OSPV to vessel volume and as percentile of lipidic plus necrotic volume to OSPV. Coronary angioscopy at follow-up rated the degree of arterial repair by neointimal stent coverage (NSC).
Poor NSC was found in approximately 60% of each G2-DES. In BES, % OSPV at baseline was significantly greater in poor NSC than in good NSC (36.2 ± 3.9 vs. 27.3 ± 4.0%, P = 0.01). In EES, %OSPV was significantly greater in poor NSC than in good NSC (41.0 ± 4.1 vs. 32.6 ± 2.7%, P < 0.01). In R-ZES implantation, there was no significant difference with regards to %OSPV between poor and good NSC. In BES, VPI at baseline was significantly greater in poor NSC than good NSC (54.0 ± 5.8 vs. 42.2 ± 5.1%, P = 0.02). There was no significant difference with regards to VPI between poor and good NCS in EES and R-ZES.
Impact of out-stent plaque characteristics on vascular response was different among the three types of G2-DES.
本研究旨在阐明第二代药物洗脱支架（G2-DES）植入后支架外斑块特征对血管反应的影响。
纳入37例患者的39处冠状动脉病变，成功植入三种类型的G2-DES（9枚Nobori生物雷帕霉素洗脱支架，BES；15枚Xience依维莫司洗脱支架，EES；15枚Resolute佐他莫司洗脱支架，R-ZES）。在植入后即刻（基线）和植入后一年（随访），进行iMAP血管内超声（IVUS）测量支架外斑块体积（OSPV）及其成分。OSPV百分比和易损斑块指数（VPI）分别定义为OSPV占血管体积的百分比以及脂质加坏死体积占OSPV的百分比。随访时的冠状动脉血管镜检查通过新生内膜支架覆盖（NSC）对动脉修复程度进行评级。
每种G2-DES中约60%的患者NSC较差。在BES中，基线时NSC较差组的OSPV百分比显著高于NSC良好组（36.2±3.9 vs. 27.3±4.0%，P = 0.01）。在EES中，NSC较差组的OSPV百分比显著高于NSC良好组（41.0±4.1 vs. 32.6±2.7%，P < 0.01）。在R-ZES植入中，NSC较差组和良好组之间的OSPV百分比无显著差异。在BES中，基线时NSC较差组的VPI显著高于NSC良好组（54.0±5.8 vs. 42.2±5.1%，P = 0.02）。在EES和R-ZES中，NSC较差组和良好组之间的VPI无显著差异。
三种类型的G2-DES中，支架外斑块特征对血管反应的影响有所不同。
