Arakawa K, Isoda K, Sugiyabu Y, Fukuda M, Nishizawa K, Shibuya T, Nakamura H
First Department of Internal Medicine, National Defense Medical College, Saitama.
J Cardiol. 1998 Dec;32(6):379-89.
Minimizing the extent of neointimal proliferation helps to maintain the maximal vessel lumen after the treatment of stenosis. The present study examined factors influencing the predisposition to neointimal proliferation, which is a consequence of Palmaz-Schatz stenting. Serial intravascular ultrasound examinations of 32 lesions (4 lesions/patient) were performed after stenting and at 6 months follow-up in 8 non-restenotic patients. Vessel, lumen and stent cross-sectional areas (CSA) were measured. Stent-to-vessel CSA ratio at stenting, changes of lumen CSA, vessel CSA and intima CSA (neointimal proliferation) were calculated. Six months after stenting, lumen CSA was reduced corresponding to an increase of intima without change of vessel CSA (without remodeling). Greater stent-to-vessel CSA at stenting was associated with higher neointimal proliferation at follow-up. The proliferative response was the same at all stent edges. Stent CSA was reduced as stent dilation was increased. The stent CSA became smaller but stent shrinkage did not account for late lumen loss. Late lumen loss in stents is the result of neointimal proliferation in cases without restenosis, and a larger stent-to-vessel CSA ratio reflects increased neointimal proliferation, as shown at 6-month follow-up.
将血管内膜增生的程度降至最低有助于在治疗狭窄后维持最大的血管腔。本研究调查了影响血管内膜增生易感性的因素，血管内膜增生是Palmaz-Schatz支架置入术的一个后果。对8例无再狭窄患者的32处病变（每位患者4处病变）在支架置入后及随访6个月时进行了系列血管内超声检查。测量了血管、管腔和支架的横截面积（CSA）。计算了支架置入时支架与血管的CSA比值、管腔CSA、血管CSA和内膜CSA（血管内膜增生）的变化。支架置入6个月后，管腔CSA减小，对应于内膜增加，而血管CSA无变化（无重塑）。支架置入时较大的支架与血管CSA与随访时较高的血管内膜增生相关。在所有支架边缘，增殖反应相同。随着支架扩张增加，支架CSA减小。支架CSA变小，但支架收缩并非导致晚期管腔丢失的原因。在无再狭窄的情况下，支架内晚期管腔丢失是血管内膜增生的结果，如6个月随访所示，较大的支架与血管CSA比值反映了血管内膜增生增加。
