Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
Department of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
J Cardiol. 2023 Jan;81(1):91-96. doi: 10.1016/j.jjcc.2022.08.008. Epub 2022 Sep 1.
Chronic total occlusion (CTO) is a high-risk factor for stent thrombosis, but little is known about the difference in neointimal healing between CTO and non-CTO lesions regarding implanted stents. We investigated factors affecting neointimal healing after stent implantation for CTO and non-CTO lesions using angioscopy.
We retrospectively evaluated 106 stents in 85 consecutive patients between March 2016 and July 2020. Their average age was 68 ± 11 years, and participants (73 male and 12 female) underwent follow-up angiography and angioscopy 1 year after percutaneous coronary intervention (PCI). The stents (n = 106) were divided into three groups according to the lesion status at the previous PCI: CTO (n = 17), acute coronary syndrome (ACS) (n = 35), and stable coronary artery disease without CTO or non-CTO (n = 54).
The neointimal stent coverage grade was significantly lower in the CTO and ACS groups than in the non-CTO group (0.4 ± 0.5, 0.9 ± 0.8, and 1.4 ± 0.8, respectively, p < 0.001). Thrombi were significantly more frequent in CTO and ACS than in non-CTO (71 %, 51 %, and 15 %, respectively, p < 0.001). The yellow grade in CTO was comparable to that in ACS but significantly higher in CTO than in non-CTO (CTO vs. ACS vs. non-CTO 1.5 ± 0.7, 1.4 ± 0.6, and 0.9 ± 0.7, respectively, p = 0.007).
Delayed healing occurs in stents implanted for CTO lesions. Longer dual-antithrombotic therapy may be beneficial.
慢性完全闭塞（CTO）是支架血栓形成的高危因素，但关于植入支架后 CTO 和非 CTO 病变的新生内膜愈合差异知之甚少。我们通过血管镜检查研究了影响 CTO 和非 CTO 病变支架植入后新生内膜愈合的因素。
我们回顾性评估了 2016 年 3 月至 2020 年 7 月期间连续 85 例患者的 106 个支架。患者平均年龄为 68±11 岁，参与者（73 名男性和 12 名女性）在经皮冠状动脉介入治疗（PCI）后 1 年接受随访血管造影和血管镜检查。根据之前 PCI 时的病变情况，将支架（n=106）分为三组：CTO（n=17）、急性冠脉综合征（ACS）（n=35）和无 CTO 或非 CTO 的稳定型冠状动脉疾病（n=54）。
CTO 和 ACS 组的新生内膜支架覆盖率明显低于非 CTO 组（分别为 0.4±0.5、0.9±0.8 和 1.4±0.8，p<0.001）。血栓在 CTO 和 ACS 中明显比在非 CTO 中更常见（分别为 71%、51%和 15%，p<0.001）。CTO 的黄色等级与 ACS 相当，但 CTO 明显高于非 CTO（CTO 与 ACS 与非 CTO 分别为 1.5±0.7、1.4±0.6 和 0.9±0.7，p=0.007）。
CTO 病变植入支架后愈合延迟。延长双联抗栓治疗可能有益。
