血管内超声虚拟组织学成像评价可降解涂层雷帕霉素洗脱支架对冠状动脉壁的影响

目的:应用血管内超声虚拟组织学成像(VH-IVUS)观察急性冠状动脉综合征患者置入生物降解涂层雷帕霉素洗脱支架(BSES)后对原位冠状动脉血管的长期影响。方法:对41例急性冠状动脉综合征患者在术后随访时(随访时间中位数=8个月)行VH-IVUS检查,通过BSES与不可降解涂层雷帕霉素洗脱支架(DSES)作对比,评价BSES置入后对急性冠状动脉综合征患者原位冠状动脉血管的影响以及邻近管腔坏死核心组织的出现率。根据既往置入支架的类型不同分为BSES组(21例)和DSES组(20例)。结果:两组间支架近端、远端节段和支架段晚期管腔丢失,差异均无统计学意义(P均>0.05)。两组间邻近管腔坏死核心组织出现率在支架段DSES组较BSES组明显升高(73%vs.36%,P<0.01),总出现率亦升高(63%vs.44%,P<0.05),差异有统计学意义;且多表现为多个邻近管腔坏死核心组织(74%vs.33%,P=0.06)。结论:随访时VH-IVUS检查提示,在急性冠状动脉综合征患者中BSES治疗处较DSES治疗处的病变形态更加稳定。

Effect of Biodegradable Polymer Coated Sirolimus Eluting Stents on Coronary Artery Wall Morphology by Virtual Histology Intravascular Ultrasound

Objective:To observe the long term native coronary artery response after implantation of biodegradable polymer coated sirolimus eluting stents(BSES) by virtual histology intravascular ultrasound(VH-IVUS).Methods:We enrolled 41 patients who suffered from acute coronary syndrome(ACS) and received either BSES or durable polymer coated sirolimus eluting stents(DSES).BSES group,n=21,and DSES group,n=20.VH-IVUS was performed at the average of 8 months after stents implantation to assess the native artery vascular response and the incidence of necrotic core abutting to the lumen in both groups.Results:There were no statistical differences of late luminal loss in stent or stent edges between two groups,P>0.05.DSES treated segments had significantly higher incidence of necrotic core abutting to the lumen through the stent struts than BSES treated segments(73% vs.36%,P<0.01),the overall incidence were also increased in DSES group(63% vs.44%,P<0.05),and most of them showed multiple necrotic core abutting to the lumen(74% vs.33%,P=0.06).Conclusions:VH-IVUS indicates that the higher frequency of stable lesion morphometry was observed in BSES treated lesions than that in DSES treated lesions in patients with ACS.