冠状动脉支架植入术后再狭窄的临床分析研究

目的探讨冠状动脉支架植入术后再狭窄的相关因素。方法 150例接受冠状动脉支架植入手术的患者分为Ⅰ、Ⅱ、Ⅲ三组,Ⅰ组98人,植入手术后再狭窄或病变的次数为0;Ⅱ组42人,植入手术后再狭窄或病变的次数≤1;Ⅲ组10人,植入手术后再狭窄或病变的次数≥2,对其进行临床分析,探讨支架植入术后再狭窄的相关因素。结果Ⅱ组、Ⅲ组患者2型糖尿病、支架长度〉20mm、支架直径〈3mm、C型病变、弥散病变、开口病变的患者比例显著高于Ⅰ组（P〈0.05）。Logistic回归分析结果发现,2型糖尿病,支架长度〉20mm,支架直径〈3mm,C型病变都是与冠状动脉支架植入术后再狭窄有关的影响因素。结论 2型糖尿病,支架长度〉20mm,支架直径〈3mm,C型病变都与冠状动脉支架植入术后再狭窄有关。     

Comparison of Efficacy of Low- (80 mg/day) and High- (160–320 mg/day) Dose Valsartan in the Prevention of In-Stent Restenosis after Implantation of Bare-Metal Stents in Type B2/C Coronary Artery Lesions

BACKGROUND AND OBJECTIVE: Results from the VALVACE (VALsartan Versus ACE inhibition after bare metal stent implantation) trial suggest that prevention of in-stent restenosis after implantation of bare-metal stents in type B2/C coronary artery lesions is possible after administration of valsartan 80 mg/day. However, the restenosis rate in patients with stable angina was relatively high (27%) with this dosage and no different from patients taking ACE inhibitors. Therefore, a 1 : 1 matched comparison on a case-control basis was initiated in a prospective controlled registry using a higher dose of valsartan, 160-320 mg/day. METHODS: A total of 450 patients (241 men, mean age 62.7 +/- 9.1 years) with matched demographic and angiographic characteristics to patients in the VALVACE trial were treated with high-dose oral valsartan 160-320 mg/day over 6 months until control angiography. Angiographic restenosis rate, target lesion revascularization (TLR) and target vessel revascularization (TVR) rates, major adverse cardiac event (MACE) rate (death, myocardial infarction, and stent thrombosis) and mean late lumen loss were analysed after 6 months. Results were compared with the results of the VALVACE trial. Analysis of the combined results of the current study together with the VALVACE trial data enabled calculation of the gender- and dose-dependent effects of valsartan. RESULTS: In the high-dose valsartan group, the angiographic restenosis rate in 368 patients with control angiography was 7.3% compared with 19.5% in the low-dose group (VALVACE) [p < 0.0001]. Mean late lumen loss was 0.37 +/- 0.3 mm in the high-dose group compared with 0.53 +/- 0.31 mm in the VALVACE trial (p < 0.01). TLR and TVR rates were 4.3% in the high-dose group compared with 9% in the VALVACE trial (p < 0.01). The MACE rate was 0% in the high-dose group compared with 1.5% in the VALVACE trial (p < 0.01). Summarizing the data for valsartan, the in-stent restenosis rates in men were 22.7%, 13.3%, 6.7%, and 5.4% in patients receiving 80, 160, 240, and 320 mg/day, respectively. In women, the in-stent restenosis rates were 13.3% and 6.3% in patients receiving 80 and 160 mg/day, respectively; no restenosis occurred in patients receiving higher doses. CONCLUSION: Administration of high-dose oral valsartan 160-320 mg/day after implantation of bare-metal stent in type B2/C coronary artery lesions reduces angiographic in-stent restenosis, TLR, TVR, late lumen loss, and MACE rates more effectively than low-dose valsartan 80 mg/day.     

椎动脉狭窄血管成形术后支架内再狭窄危险因素相关性研究

目的 探讨椎动脉粥样硬化性狭窄患者血管内支架置入术后再狭窄的危险因素,研究再狭窄患者预后.方法 选择南京鼓楼医院2004-2013年间收治的椎动脉粥样硬化性狭窄患者173例,均行血管内支架置入术,术后随访(55.7±17.31)个月,记录其性别、年龄、合并症、吸烟史、病变部位、术前术后椎动脉直径、支架类型、支架直径、支架长度等,分析血管内支架置入术后再狭窄的危险因素以及再狭窄预后.结果 所有患者顺利完成血管内支架置入术,随访期间28例出现再狭窄,145例未出现再狭窄,再狭窄发生率为16.2％.2组患者性别、年龄、随访时间、糖尿病、高尿酸血症、冠心病、血管直径、支架类型差异均无统计学意义(P＞0.05);而再狭窄组高血压、高脂血症、吸烟、和颅外V1段、颅内V4段支架植入位置均明显高于非再狭窄组(P＜0.05).多因素logistics回归分析显示,高脂血症(HR:4.31,95％CI: 2.99～18.76,P=0.042)为再狭窄危险因素.再狭窄组卒中发生风险明显高于非再狭窄,Kaplan-Meier分析结果显示,再狭窄组卒中终点事件风险高(OR: 0.141,95％CI: 0.016～1.221,P=0.029),差异有统计学意义.结论 椎动脉起始部粥样硬化性狭窄患者血管内支架置入术后再狭窄发生率较高,高脂血症是再狭窄独立危险因素,再狭窄患者发生卒中事件风险高.     

血清胆红素水平与冠脉支架植入术后再狭窄的相关性研究

目的探讨冠状动脉(冠脉)内药物涂层支架植入术后支架内再狭窄与血清胆红素的相关性。方法对82例成功行经皮冠脉药物涂层支架植入术的患者术后再次行冠脉造影,以原病变冠脉直径狭窄程度≥50%为支架内再狭窄,按有无再狭窄分为再狭窄组16例和非再狭窄组66例。比较2组胆红素等临床血清学指标及临床资料,探讨血清胆红素是否与支架内再狭窄有关。结果再狭窄组总胆红素水平低于非再狭窄组,差异有统计学意义(P<0.05)。Logistic多因素回归分析显示空腹血糖、尿酸是再狭窄的危险因素,总胆红素是再狭窄的保护因素(P<0.05)。结论血清总胆红素与冠脉支架内再狭窄密切相关,高水平总胆红素可能降低冠脉支架内再狭窄的发生。     

冠心病患者不同支架术后炎性反应因子的变化

目的 观察不同支架术对冠心病患者血中白细胞介素6(IL-6)、白细胞介素18(IL-18)、C反应蛋白(CRP)的影响.方法 对冠心病患者行支架植入术,按植入的支架分为普通支架组和紫杉醇支架组,于术前及术后24h、48 h、72 h、7d检测血清CRP、IL-6及IL-18水平.结果 紫杉醇支架组CRP、IL-6及IL-18峰值分别为(11.25 ±2.15) mg/L、(8.91±2.31) μg/L、(0.95±0.16) μg/L,均明显低于普通支架组的(15.56±3.37)mg/L、(12.35±3.12) μg/L、(1.15±0.18) μg/L(均P＜0.05).随访6个月,紫杉醇支架组再狭窄发生率为7.5％,明显低于普通支架组的26.3％(P＜0.05).结论 紫杉醇支架可以降低触发炎性反应的程度和再狭窄率.     

冠心病患者应用药物洗脱支架临床观察

目的 研究Excel药物洗脱支架治疗冠状动脉原发病变的临床疗效.方法 入选2004年9月2008年3月接受Excel药物洗脱支架治疗的冠心病患者692例.观察术后30 d和3、9及12个月主要心脏不良事件发生率,支架内再狭窄率和靶血管重建率.结果 与中国Cypher select注册研究比较,接受Excel支架治疗的患者和接受Cypher支架治疗的患者在术后12个月支架内再狭窄率(9.1%比9.6%,P>0.05)和主要心脏不良事件发生率(3.8%比6.5%,P>0.05)方面差异无统计学意义.结论 Excel西罗莫司洗脱支架和Cypher西罗莫司洗脱支架近期疗效相似.

Abstract：

Objective To study the effects of excel simlimus eluting stent on patients with coronary heart disease.Methods Totally 692 patients having excel stent therapy were enrolled in this study.Twelve months follow-up for major adverse cardiac events(MACE)rate,restenosis rate and target lesion revascularization rate was performed. Results Compared with Chinese Cypher Select Registry Study,patients having Excel stent therapy had no significant difference in 12 months restenosis rate(9.1%VS 9.6%,P>0.05)and 12 months MACE rate 13.8%vs 6.51%,P>0.05).Conclusion The efficacy and safety of excel sirolimus eluting stent is as good as Cypher eluting stent.     

Spotlight on the sirolimus-eluting stent in coronary artery disease

The sirolimus-eluting stent (CYPHER?) is a metal stent coated with 140 μg/cm² of sirolimus blended with synthetic polymers. After stent implantation, sirolimus is slowly released causing localized cytostatic inhibition of proliferation of vascular smooth muscle cells in the peri-stent arterial wall over a period of about 1 month. Only minimal amounts of sirolimus enter the bloodstream and these appear to be insufficient to be of clinical relevance. In clinical trials that evaluated single de novo lesions and in-stent restenosis in patients with coronary artery disease, the sirolimus-eluting stent was associated with minimal neointimal hyperplasia. In four randomized trials in de novo lesions, sirolimus eluting stents produced a significantly lower incidence of major adverse cardiac events (MACE) than that observed in patients with uncoated stents, during periods of up to 2 years (p < 0.05 for all comparisons). The lower incidence of MACE was mostly due to a reduced requirement for repeat target vessel revascularization. At angiographic follow-up at periods of up to 8 months, late luminal loss was significantly smaller in the sirolimus-eluting stent groups than in the uncoated-stent groups (p < 0.001 in all studies). The sirolimus-eluting stent was well tolerated in clinical trials of up to 3 years’ follow-up. Because minimal blood levels of sirolimus are achieved, systemic adverse effects appear to be avoided. To date, there has been no evidence of any potential adverse effects resulting from the polymer coating or local drug toxicity. As yet, there is no evidence of an increased risk of subacute or late thrombosis, or aneurysm formation with the sirolimus-eluting stent compared with the uncoated stent. Long-term follow-up is needed to fully assess these theoretical concerns. Cost-effectiveness analyses over 12 months demonstrated a cost advantage for the sirolimus-eluting stent compared with an uncoated stent because of a reduced requirement for repeat target vessel revascularizations. Conclusion: Initial clinical trials with the sirolimus-eluting stent in patients with de novo coronary lesions have shown a significantly reduced incidence of MACE and of restenosis compared with a standard stent. Efficacy appears to be maintained throughout follow-up periods of up to 2 years in randomized trials, and to date, systemic or local adverse effects have been avoided. If efficacy and tolerability are consistently demonstrated over the long term, the sirolimus-eluting stent will be a major advance in the control of in-stent restenosis.     

Sirolimus- or paclitaxel-eluting stents to prevent coronary artery restenosis

The restenosis rate is lower with stent implantation than with balloon angioplasty. Nevertheless, even with the use of stenting, restenosis still occurs in approximately one-third of patients with diabetes, small coronary vessels, and long lesions. The two drugs commonly used in eluting stents are sirolimus and paclitaxel. Systemically administered sirolimus decreased vascular proliferation in animal models. After preliminary trials showing benefit with sirolimus-eluting stents in de novo coronary lesions, the large-scale SIRIUS (Sirolomus-coated Bx Velocity balloon-expandable stent in the treatment of patients with de novo coronary artery lesions) trial was undertaken. SIRIUS showed that sirolimus reduced restenosis and target vessel revascularisation, compared to bare stents. These benefits were also apparent in the diabetic, and small- and long vessel subgroups. The RESEARCH (Rapamycin-eluting Stent Evaluated At Rotterdam Cardiology Hospital) registry have established that sirolimus-eluting stents are superior to bare stents in practice. Thus, the benefits of sirolimus-eluting stents over bare stents have been clearly established, and sirolimus can be considered the benchmark eluting agent for the prevention of coronary artery restenosis. Animal studies with paclitaxel-eluting stents, mainly in endothelium denuded normal vessels, have shown that paclitaxel reduces restenosis in the short-term, and that this may be a delay, rather than a prevention of restenosis. In clinical trials, stents eluting the paclitaxel derivative 7-hexanolytaxol, or paclitaxel without a polymer, delay rather than prevent restenosis. Slowing the release of paclitaxel with a polymer base in the TAXUS (Taxol(trade mark) [paclitaxel]-eluting stent) series of clinical trials reduced the revascularisation rate at 12 and 18 months, indicating that polymer-based paclitaxel is effective for longer. The results of the REALITY trial comparing the sirolimus- and paclitaxel-eluting stents in diabetics and other high-risk patients are eagerly awaited.     

Sirolimus- or paclitaxel-eluting stents to prevent coronary artery restenosis

The restenosis rate is lower with stent implantation than with balloon angioplasty. Nevertheless, even with the use of stenting, restenosis still occurs in approximately one-third of patients with diabetes, small coronary vessels, and long lesions. The two drugs commonly used in eluting stents are sirolimus and paclitaxel. Systemically administered sirolimus decreased vascular proliferation in animal models. After preliminary trials showing benefit with sirolimus-eluting stents in de novo coronary lesions, the large-scale SIRIUS (Sirolomus-coated Bx Velocity balloon-expandable stent in the treatment of patients with de novo coronary artery lesions) trial was undertaken. SIRIUS showed that sirolimus reduced restenosis and target vessel revascularisation, compared to bare stents. These benefits were also apparent in the diabetic, and small- and long vessel subgroups. The RESEARCH (Rapamycin-eluting Stent Evaluated At Rotterdam Cardiology Hospital) registry have established that sirolimus-eluting stents are superior to bare stents in practice. Thus, the benefits of sirolimus-eluting stents over bare stents have been clearly established, and sirolimus can be considered the benchmark eluting agent for the prevention of coronary artery restenosis. Animal studies with paclitaxel-eluting stents, mainly in endothelium denuded normal vessels, have shown that paclitaxel reduces restenosis in the short-term, and that this may be a delay, rather than a prevention of restenosis. In clinical trials, stents eluting the paclitaxel derivative 7-hexanolytaxol, or paclitaxel without a polymer, delay rather than prevent restenosis. Slowing the release of paclitaxel with a polymer base in the TAXUS (Taxol^? [paclitaxel]-eluting stent) series of clinical trials reduced the revascularisation rate at 12 and 18 months, indicating that polymer-based paclitaxel is effective for longer. The results of the REALITY trial comparing the sirolimus- and paclitaxel-eluting stents in diabetics and other high-risk patients are eagerly awaited.     

Pharmacological inhibition of coronary restenosis: systemic and local approaches

Introduction: Percutaneous coronary intervention (PCI) with stent implantation has revolutionized the treatment of obstructive coronary artery disease. However, the main limitation of this therapy is stent failure, which is usually caused by in-stent restenosis.

Areas covered: The aim of this article is to critically review the literature on the prevention of in-stent restenosis focusing on drug compounds that have reached clinical testing.

Expert opinion: The pathophysiological response following PCI includes many possible targets for antirestenosis treatment. Most notable success is seen with sirolimus (and its analogs) and paclitaxel, both of which target vascular smooth muscular cell proliferation. In view of the systemic side effects of both drugs, the high efficacy of local drug delivery methods reduced enthusiasm for systemic therapy. Cilastazol has shown benefit in restenosis reduction particularly in patients at high risk for stent failure, though further study in broader populations is warranted. Probucol showed variable results, but local drug delivery in combination with sirolimus seems promising. A hypothesized independent antirestenotic effect of pioglitazone in patients with diabetes has not been clearly demonstrated. Initial encouraging results with tranilast have not been replicated in a recent large-scale randomized trial. Colchicine and prednisone have shown promising results but require further investigation in larger clinical trials.     

术前sCD_(40)L预测冠状动脉支架后再狭窄的临床价值研究

目的:探讨冠状动脉粥样硬化性心脏病患者支架植入术前sCD40L对再狭窄的诊断预测价值。方法:选择成功接受普通支架置入术的稳定型心绞痛和不稳定型心绞痛患者共92例,分别于支架术前,术后1,5,15d和180d取外周静脉血测定血清sCD40L。所有患者随访6个月。结果:支架内再狭窄率23.9%(22/92)。再狭窄患者支架术前和术后血清sCD40L水平均显著高于无再狭窄患者(P均<0.01);再狭窄患者支架术后高水平sCD40L持续至术后6个月,而无再狭窄患者术后5d则恢复至正常。根据受试者工作特征曲线确定术前血清sCD40L>3.96μg/L为截断值,计算术前sCD40L诊断再狭窄的敏感性、特异性、阳性预测值、阴性预测值、准确度和阳性似然比分别为72.7%、90%、69.6%、91.3%、85.9%和7.27。多变量Logistic回归分析发现,在校正混杂因素后,术前sCD40L是术后再狭窄独立预测因子,OR=1.92(95%CI=1.39～2.64,P=0.013)。结论:再狭窄患者支架术前、术后血清sCD40L水平增加提示sCD40L可能与支架内再狭窄有关。支架术前血清sCD40L是术后再狭窄的独立预测因子,术前sCD40L有可能用于临床支架放置前危险分层的评价。     

药物洗脱支架置入对糖尿病并发冠心病患者不良心血管事件的影响

目的评价药物洗脱支架置人对糖尿病并发冠心病患者不良事件的影响。方法对600例行药物洗脱支架植入术的患者进行随访,其中糖尿病患者147例。通过随访术后主要不良心血管事件（包括死亡,非致死性心肌梗死,再次靶病变血运重建和再次靶血管血运重建）和支架内再狭窄的发生率评价药物洗脱支架在糖尿病患者中的疗效。结果糖尿病患者和非糖尿病患者术后的主要不良心血管事件（7．9％与4．9％,P=0．344）和支架内再狭窄（6．0％与4．9％,P=0．540）发生率之间差异元统计学意义。糖尿病患者植入Cypher和TAXUS支架后主要不良心血管事件（7．9％与4．9％,P=0．344）和支架内再狭窄（1．4％与1．9％,P=1．000）发生率之间差异无统计学意义。结论糖尿病患者使用药物洗脱支架是安全有效的,且Cypher和TAXUS两种支架在糖尿病患者中疗效差异无统计学意义。     

Neointimal Hyperplasia Inhibition Effect of Angiotensin II Type 1 Receptor Blockers in Patients after Coronary Stent Implantation

Background and Objective

It remains unclear whether angiotensin II type 1 receptor antagonists (angiotensin receptor blockers [ARBs]) can inhibit neointimal hyperplasia after stent implantation in patients with coronary artery disease. The aim of this meta-analysis was therefore to evaluate the benefits of ARBs in patients after coronary stent implantation based on the currently available randomized controlled trials.

Methods

We conducted a pooled analysis of randomized controlled trials to compare outcomes after stent implantation in patients administered ARBs with those not administered ARBs. We searched Ovid/MEDLINE, EMBASE, and the ISI web of knowledge using the terms ‘angiotensin receptor blocker,’ ‘renin angiotensin system inhibitor,’ ‘angiotensin receptor antagonist,’ ‘stent,’ ‘angiograph,’ ‘percutaneous coronary intervention (PCI),’ and ‘coronary artery disease.’ Published meta-analyses, review articles, and editorials were reviewed for potential studies of interest. The inclusion criteria were randomized controlled trials published in English, with a follow-up period of 6 months, comparing the outcomes after coronary stent implantation with and without the administration of any kind of ARB, reporting at least one outcome of interest (restenosis rate and late lumen loss). Data abstraction included study design, patient characteristics, follow-up period, type of ARB, type of stent, restenosis rate, and late lumen loss. Fixed-effects models were used to calculate the pooled relative risk for the restenosis rate and the standardized mean difference for late lumen loss.

Results

Five studies were included, with a total number of 624 patients. Seventy-five of 314 patients in the ARB group were diagnosed with in-stent restenosis at the 6-month follow-up, compared with 87 of 310 patients in the control group (relative risk 0.85; 95% CI 0.65, 1.11; p = 0.23). Consistent with this, there was no significant difference in late lumen loss between the two groups (0.04 mm; 95% CI ?0.15, 0.23; p = 0.66).

Conclusion

There is no evident benefit with the use of an ARB in terms of inhibition of neointimal hyperplasia in patients after coronary stent implantation.     

血清tPSA、fPSA和f／tPSA在前列腺癌合并冠状动脉支架置入患者中诊断作用的评价

目的 探讨冠状动脉支架置入患者血清总PSA（tPSA）、游离PSA（fPSA）和游离PSA/总PSA比值（f/tPSA）水平变化,以评价其在前列腺癌合并冠状动脉支架置入患者诊断中的价值.方法 对50例可疑冠心病男性患者行冠状动脉造影术,20例冠状动脉造影正常（组1）,30例患者行冠状动脉支架置入术（组2）.测定两组冠状动脉造影和支架置入前,后24 h和30 d时的tPSA、fPSA和f/tPSA值.结果 冠状动脉造影正常组患者（组1）tPSA、fPSA和f/tPSA值在冠状动脉造影术前后无显著性差异（P＞0.05）.冠状动脉支架置入术患者（组2）术后24小时tPSA、fPSA有显著性差异（P＜0.01）,而f/tPSA无显著性差异（P＞0.05）,术后30天tPSA、fPSA和f/tPSA值均无显著性差异（P＞0.05）.结论 冠状动脉置入术可引起tPSA、fPSA值明显升高,到术后30天时恢复正常范围.tPSA、fPSA值不能用于冠状动脉置入术后30天内前列腺癌的早期诊断.     

冠状动脉内支架在冠状动脉分叉处病变中的应用

目的：观察应用NIR冠状动脉支架治疗血管分叉处病变的临床及冠状动脉造影的结果。方法：将36例冠状动脉分叉处病变的患者均置入NIR支架，并观察患者发生临床事件及6个月后的冠状动脉造影结果。结果：6个月后完成临床及冠状动脉造影随访的患者32例，无1例发生急性冠状动脉闭塞、急性心肌梗死，3例发生了内支架再狭窄（9．38％，直径＞50％），仅有1例发生再狭窄后出现心绞痛（33．3％），3例分叉处血管发生再狭窄（9．38％，其狭窄程度＞60％），有1例于术后第10天出现急性肺栓塞死亡。结论：冠状动脉血管分叉处病变的患者经皮冠状动脉腔内成形术（PTCA）成功后置入NIR支架，其发生临床事件及再狭窄率低，近、远期临床疗效及预后好。     

Sirolimus- versus paclitaxel-eluting stents in patients with stenosis in a native coronary artery

With stenting, restenosis occurs in ~ 25% of patients and the incidence is even higher in patients with diabetes, small coronary vessels and long lesions. The sirolimus-eluting balloon-expandable stent in the treatment of patients with de novo native coronary-artery lesions (SIRIUS) trial, enrolled patients with more challenging conditions, including a higher frequency of diabetes, more complex lesion morphology and longer lesions and showed benefits in all groups. After 240 days, the frequency of stenosis of at least 50% of the luminal diameter was 3.2 and 35.4% in the sirolimus and standard stents groups, respectively. The TAXUS-IV trial was the first large-scale trial on the safety and efficacy of paclitaxel-eluting stents in a broad population of patients and lesions, and established the safety and effectiveness of this agent. After 9 months, there was a mean stenosis of 17% in the paclitaxel group compared to 37% of patients treated with a bare stent. Thus, the local delivery of potent cell cycle inhibitors (sirolimus, paclitaxel) from stents being used for revascularisation dramatically decreases the incidence of restenosis in the populations of patients studied so far and represents a major advancement in the treatment of coronary artery disease.     

Sirolimus- versus paclitaxel-eluting stents in patients with stenosis in a native coronary artery

With stenting, restenosis occurs in approximately 25% of patients and the incidence is even higher in patients with diabetes, small coronary vessels and long lesions. The sirolimus-eluting balloon-expandable stent in the treatment of patients with de novo native coronary-artery lesions (SIRIUS) trial, enrolled patients with more challenging conditions, including a higher frequency of diabetes, more complex lesion morphology and longer lesions and showed benefits in all groups. After 240 days, the frequency of stenosis of at least 50% of the luminal diameter was 3.2 and 35.4% in the sirolimus and standard stents groups, respectively. The TAXUS-IV trial was the first large-scale trial on the safety and efficacy of paclitaxel-eluting stents in a broad population of patients and lesions, and established the safety and effectiveness of this agent. After 9 months, there was a mean stenosis of 17% in the paclitaxel group compared to 37% of patients treated with a bare stent. Thus, the local delivery of potent cell cycle inhibitors (sirolimus, paclitaxel) from stents being used for revascularisation dramatically decreases the incidence of restenosis in the populations of patients studied so far and represents a major advancement in the treatment of coronary artery disease.     

RACTS: a prospective randomized antiplatelet trial of cilostazol versus ticlopidine in patients undergoing coronary stenting: long-term clinical and angiographic outcome

We compared the efficacy of cilostazol for the prevention of late restenosis and acute or subacute stent thrombosis with that of ticlopidine. Cilostazol has been used for antiplatelet therapy after coronary stent implantation, but the results are controversial. Patients scheduled for stent implantation were randomly assigned to receive either cilostazol (100 mg twice daily for 6 months, n=201) or ticlopidine (250 mg twice daily for 1 month, n=196). All patients also received oral aspirin (100 mg once daily for 6 months). Coronary angiography was performed at baseline and immediately and 6 months after coronary stenting. Clinical follow-up was continued up to 9 months postprocedure. There was no significant difference in the composite incidence of death, myocardial infarction, stroke, and stent thrombosis between the 2 groups [cilostazol (1.5%) versus ticlopidine (3.6%), P=0.216], but the target lesion revascularization rate per patient was significantly lower in the cilostazol group than in the ticlopidine group (22.9% vs 32.7%, P=0.030) 9 months post-coronary stenting. Medication withdrawn because of drug-related side effects tended to be higher in the ticlopidine group than that in the cilostazol group (3.5% vs 8.2%, P=0.054). At follow-up angiography, the minimal luminal diameters (2.31+/-1.06 vs 2.10+/-1.16, P=0.057) tended to be larger and the restenosis rates lower (23.3% vs 30.9%, P=0.086) in the cilostazol group than in the ticlopidine group. Aspirin plus cilostazol is a comparable antithrombotic regimen to aspirin plus ticlopidine after elective coronary stenting, but the rate of target lesion revascularization was significantly lower in the cilostazol group than in the ticlopidine group.     

逐瘀通脉方对脑血管支架内血栓形成的预防作用

目的通过给予脑血管支架术后患者口服逐瘀通脉方,评价其预防支架内血栓形成的效果。方法颈内动脉、椎基底动脉及颅内动脉严重狭窄患者择期行血管内支架成型术,术后随机分为两组,对照组常规应用氯比格雷加阿司匹林口服;治疗组在对照组用药的基础上加服逐瘀通脉方。术后6个月复查脑血管造影,计算机定量测定血管病变的直径狭窄程度(QCA),多普勒(TCD)检查脑血管参数,同时应用ELISA法检测TXA2、PGI2及TXA2/PGI2等指标。结果治疗组(n=62)参照血管直径与对照组(n=63)无明显差异,支架段血管直径差异不明显[(3.32±0.21)mm vs(3.18±0.25)mm,P>0.05)]。血管直径减少指数治疗组与对照组分别为(0.41±0.11)与(0.65±0.16),P<0.05。治疗组再狭窄率(11.3%)及再介入率(3.06%)均明显低于对照组(23.8%、11.1%,P<0.05)。结论逐瘀通脉方干预可降低脑血管内支架成型治疗术后再狭窄的发生率。