雷帕霉素涂层支架预防血管内再狭窄的研究进展

如何防治冠状动脉介入治疗术后再狭窄形成已成为当今介入心脏学界面临的一大挑战 ,近年来的研究表明雷帕霉素涂层支架可有效预防再狭窄形成 ,为解决这一难题提供了新的治疗手段。本文就目前雷帕霉素涂层支架在临床防治再狭窄研究的最新进展作一综述。     

雷帕霉素涂层支架对支架内早期再狭窄的预防

目的 :评价乳酸和乙醇酸聚合物携带雷帕霉素并以支架为载体抑制血管新生内膜的作用和预防支架内再狭窄的有效性。方法 :采用随机、双盲试验 ,在 2 0头微型猪的冠状动脉前降支或左旋支分别置入支架 1枚 ,其中金属裸支架 8枚 ;雷帕霉素涂层支架 12枚。涂层材料选用乳酸和乙醇酸聚合物 ,根据两种材料比例将涂层支架分为雷帕霉素缓慢释放涂层支架 (药物剂量 6 5～ 90 μg/支架 ,5枚 )和雷帕霉素快速释放涂层支架 (药物剂量 6 8～ 96 μg/支架 ,7枚 )。2 8d后进行冠状动脉造影 ,术后处死动物 ,取出支架血管 ,进行组织学分析。 结果 :对照组的再狭窄率为 2 5 .0 % (2 /8) ;两组雷帕霉素涂层支架均为 0 %。平均狭窄程度 :对照组为 (31± 2 2 ) % ,雷帕霉素缓慢释放涂层支架组减少了 2 8% (P <0 .0 5 ) ;雷帕霉素快速释放涂层支架组减少了 2 3% (P <0 .0 5 ) ;新生内膜面积 :对照组 (2 .18± 1.0 3)mm2 ;雷帕霉素缓慢释放涂层支架组减少了 1.0 9mm2 (P <0 .0 5 ) ;雷帕霉素快速释放涂层支架组减少了 1.2 4mm2 (P <0 .0 5 )。结论 :乳酸和乙醇酸聚合物携带雷帕霉素涂层支架可以降低支架内的狭窄程度 ,有效地减少血管内新生内膜面积 ,预防支架内的狭窄     

雷帕霉素涂层支架预防再狭窄的进展

冠状动脉内支架植入术在经皮治疗冠状动脉粥样硬化性心脏病中已成为最普遍的技术，其数量在世界范围内已超过整个经皮冠状动脉内手术的75％。尽管支架植入比球囊成形可降低再狭窄的发生，但仍有15％～35％的病例发生支架内再狭窄…。所以，需要一个有效的预防和治疗手段来防治支架内再狭窄。     

雷帕霉素和甲氨蝶呤涂层支架预防支架内再狭窄的实验研究

目的　评价雷帕霉素涂层支架、甲氨蝶呤涂层支架以及雷帕霉素和甲氨蝶呤混合涂层支架抑制血管新生内膜的作用和预防支架内再狭窄的有效性。方法　本实验采用随机、双盲试验 ,在2 5头微型猪的冠状动脉前降支或左旋支分别置入支架 1枚 ,其中金属裸支架 8枚、甲氨蝶呤涂层支架(每枚支架药物剂量 2 5 0～ 30 0 μg) 5枚、雷帕霉素涂层支架 (每枚支架药物剂量 6 8～ 96 μg) 7枚、雷帕霉素和甲氨蝶呤混合涂层支架 (每枚支架含雷帕霉素 5 8～ 81μg、甲氨蝶呤 12 0～ 170 μg) 5枚。 2 8d后进行冠状动脉造影随访 ,术后处死动物 ,取出支架血管 ,进行组织学分析。结果　再狭窄率 :对照组为2 5 % ( 2 8) ,甲氨蝶呤组为 80 % ( 4 5 ) ,其余 2组为 0。平均狭窄程度 :对照组为 31%± 2 2 % ,甲氨蝶呤涂层支架组为 6 4 %± 2 5 % (P <0 0 5 ) ,雷帕霉素涂层支架组为 8%± 17% (P <0 0 5 ) ,雷帕霉素和甲氨蝶呤混合涂层支架组为 3%± 4 % (P <0 0 5 )。新生内膜面积 :对照组为 ( 2 18± 1 0 3)mm2 ,甲氨蝶呤涂层支架组为 ( 3 93± 1 4 8)mm2 (P =0 0 6 9) ;雷帕霉素涂层支架组为 ( 0 94± 0 88)mm2 (P <0 0 5 ) ,雷帕霉素和甲氨蝶呤混合涂层支架组为 ( 0 4 7± 0 2 4 )mm2 (P <0 0 5 )。结论　在本实验中     

应用雷帕霉素药物涂层支架治疗冠脉支架内再狭窄研究

目的 :评价雷帕霉素药物涂层支架 (CYPHERCordis)治疗冠脉支架内再狭窄的临床效果。方法 :我院在 2 0 0 2年 10月至 2 0 0 3年 10月对 2 1例冠心病冠脉支架内再狭窄患者置入CYPHERTM支架(Cordis)治疗 ,对 16例前降支支架内再狭窄患者置入CYPHER支架 16个 ,4例右冠支架内再狭窄患者置入CYPHER支架 4个 ,1例回旋支支架内再狭窄患者置入CYPHER支架 1个。观察药物涂层支架的手术成功率 ,术中并发症 ,住院期间及 2 14个月随防期间的心绞痛、心肌梗塞、猝死 ,再次血运重建等发生情况。结果 :手术即刻成功率 10 0 % ,术后造影病变残余狭窄率为 5 %± 3 5 % ,支架完全覆盖病变 ,支架近远段无新夹层 ,血流TIMI3级 ,临床随访 2～ 14个月 2 1例心绞痛消失 ,其中 12例 6～9个月 ,复查冠脉造影 ,无支架内再狭窄发生。结论 :雷帕霉素药物涂层支架 (CYPHER) ,治疗冠脉支架内再狭窄是安全有效的 ,短期临床随访结果明显优于单纯再次扩张及首次置入普通支架的临床效果     

雷帕霉素-巴曲酶复合药物涂层支架预防支架内再狭窄的实验研究

目的评价雷帕霉素-巴曲酶复合药物涂层支架对再狭窄和支架内血栓的防治作用及安全性,减少术后抗血小板药物的应用及并发症的发生率。方法采用随机、双盲试验在16头微型猪的冠状动脉前降支或左旋支分别置入支架1枚,其中雷帕霉素涂层支架（每枚支架药物剂量1.2μg/mm2）共8枚,为对照组;雷帕霉素-巴曲酶复合药物涂层支架（每枚支架含雷帕霉素1.2μg/mm2、巴曲酶0.3μg/mm2）共8枚,为实验组。对照组术前3 d起每天口服氯吡格雷75 mg和阿司匹林0.3 g直至28 d处死;实验组术前3 d至术后7 d每天口服氯吡格雷75 mg和阿司匹林0.3 g,此后改为每天口服阿司匹林0.3 g,直至28 d处死。28 d时进行冠状动脉造影随访,术后处死动物,取出支架血管,进行组织学分析。结果再狭窄率:对照组为0,实验组为0。管腔丢失率:对照组为（7±5）%,实验组为（4±3）%。新生内膜面积:对照组为（1.0±0.8）mm2,实验组为（0.9±0.7）mm2。结论雷帕霉素-巴曲酶复合药物涂层支架与单纯雷帕霉素涂层支架比较可以减少支架置入术后的口服氯吡格雷总量及用药时间。     

雷帕霉素-替罗非班复合药物涂层支架预防支架内血栓和再狭窄的实验研究

目的探讨雷帕霉素-替罗非班复合药物涂层支架预防支架内血栓和再狭窄的疗效及机制。方法8只小型猪随机分为单纯雷帕霉素涂层支架（RES）组和雷帕霉素-替罗非班复合药物涂层支架（RTES）组,每只动物于冠状动脉中置入支架2枚。术后RES组服用阿司匹林300 mg/d和氯吡格雷75 mg/d,3个月;RTES组服用阿司匹林300 mg/d,3个月,氯吡格雷75 mg/d,1个月。实验期间对动物行为学和出凝血障碍等并发症进行观察。3月后复查冠状动脉造影,处死动物,取出支架血管段,行组织病理学分析。结果①两组均未发现急性、亚急性和远期血栓,无出凝血等并发症发生。②支架部位血管腔面积:雷帕霉素涂层支架组为（4.89±0.46）mm2,雷帕霉素-替罗非班复合涂层支架组为（4.96±0.35）mm2;新生内膜面积:雷帕霉素涂层支架组为（1.05±0.09）mm2,雷帕霉素-替罗非班复合涂层支架组为（1.12±0.10）mm2;管腔面积丢失率:雷帕霉素涂层支架组为（21±7）%,雷帕霉素-替罗非班复合药物涂层支架组为（19±9）%。结论①雷帕霉素-替罗非班复合药物涂层支架可有效预防PC I术后支架内血栓形成。②雷帕霉素-替罗非班复合药物涂层支架防治支架内再狭窄的疗效与单纯雷帕霉素支架无差异。     

雷帕霉素洗脱支架预防再狭窄23例的临床观察

目的:观察雷帕霉素洗脱支架对减少再狭窄的效果及安全性。方法:对入选的23例患者应用球囊预扩张后置入雷帕霉素支架,术后1、3、6个月进行临床随访,术后6个月造影随访。结果:23例患者25只支架全部置入成功。术后6个月发生重要心脏不良事件、靶血管失败、支架内血栓形成及穿刺处血管并发症各1例。术后6个月23例患者中18例进行了造影复查,仅1例(5.6%)发生支架内再狭窄,病变血管为前降支,狭窄程度为50%。结论:应用雷帕霉素洗脱支架进行冠状动脉介入治疗有效、安全。     

雷帕霉素-缬沙坦复方药物洗释支架预防支架内再狭窄的实验研究

目的　探讨雷帕霉素 -缬纱坦复方药物洗释支架 (复方药物洗释支架 )对支架植入术后再狭窄的预防作用。方法　对 2 2只雄性新西兰白兔进行腹主动脉拉伤后分别植入复方药物洗释支架 (复方组 )和普通支架 (裸支架组 )各 11只。两组均在术后 8周行血管内超声检查和腹主动脉行造影检查。结果　支架部位血管腔面积裸支架组小于复方组 (P <0 0 1)、支架内增生内膜面积及内膜增生程度裸支架组大于复方组 (P <0 0 0 1)。结论　复方药物洗释支架在动物实验中具有明显预防支架内再狭窄的作用     

雷帕霉素防治冠状动脉再狭窄的研究进展

经皮腔内冠状动脉成形术 (PTCA)已成为冠心病患者的重要的治疗手段之一 ,但术后 6个月内再狭窄的发生率高达 30 %～ 5 0 % ,支架置入术后再狭窄率亦高达 1 0 %～ 2 0 % ,为了克服这一难题 ,学者们进行了各种尝试和研究 ,包括药物疗法和放射疗法。目前看来 ,最为有效并有明确临床应用前景的药物是雷帕霉素 (rapamycin ,RPM )和紫杉醇。本文现就RPM在防治冠状动脉再狭窄中的进展作一扼要综述。1　RPM的一般特性及作用机制RPM于 1 975年由加拿大Ayerst研究所发现。纯净RPM为白色结晶 ,分子式C56H89NO1 4 ,分子量 91 4.2 ,易溶于甲醛…     

雷帕酶素和巴曲酶复合药物涂层支架预防支架内再狭窄的实验研究

目的评价裸支架、巴曲酶支架、雷帕酶素支架、雷帕酶素和巴曲酶复合药物涂层支架（rapamycin-batroxobin eluting stent,RBES）抑制内膜增生的作用以及预防支架内再狭窄的效果。方法采用微喷法制备雷帕酶素和巴曲酶复合药物涂层支架,将裸支架、巴曲酶支架和雷帕酶素支架做为对照,复合药物组减少术后服用氯吡格雷的剂量和时间。于支架置入后3、7、28d截取支架段血管连同邻近的近端正常血管段,通过病理组织学分析和聚合酶链反应技术检测支架局部内膜增生情况。结果复合药物支架、雷帕酶素支架在再狭窄率、冠脉狭窄程度、管腔面积、新生内膜面积方面与裸支架组、巴曲酶支架组有显著差异（P<0.05）。复合药物支架组与雷帕酶素组在再狭窄率、冠脉狭窄程度、管腔面积、新生内膜面积方面无显著差异。裸支架组、巴曲酶支架组在再狭窄率、冠脉狭窄程度、管腔面积、新生内膜面积方面无显著差异。正常血管段在各个时间段增殖细胞核抗原（PCNA）mRNA均呈现无明显差异的低表达。裸支架、巴曲酶支架、雷帕酶素支架和复合药物支架置入后3d局部血管壁PCNA mRNA即呈现高表达,裸支架、巴曲酶支架显著高于正常血管段。雷帕酶素支架和复合药物支架略高于正常血管段,显著低于裸支架、巴曲酶支架,巴曲酶支架略低于裸支架;复合支架略低于雷帕酶素支架。结论复合药物支架置入可在一定程度上抑制内膜的增生反应,预防支架内再狭窄。     

雷帕霉素洗脱支架治疗支架术后的再狭窄

目的探讨雷帕霉素洗脱支架(CypherTM)在支架术后再狭窄介入治疗中的安全性和有效性。方法分析在支架术后发生再狭窄而再次介入治疗并置入CypherTM支架的21例患者的即刻疗效和血管造影随访结果。结果21例患者介入治疗均获得成功,21处病变共置入24枚CypherTM支架。住院期间未发生有关的严重并发症。随访期6~12个月,平均为(9.2±3.0)个月内未出现心脏事件。21例患者共有18例复查了冠状动脉造影,CypherTM支架内均无再狭窄。结论CyperTM支架在再狭窄的介入治疗中安全有效。     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

雷帕霉素涂层支架治疗老年人冠心病的疗效及再狭窄的随访分析

目的 观察雷帕霉素涂层冠状动脉Cypher支架治疗老年冠心病患者的临床疗效及再狭窄情况。方法 2002年11月至2005年5月在我院心导管室接受Cypher支架治疗的328例60岁以上的老年冠心病患者，观察术后即刻效果，随访6个月记录心脏性死亡、心肌梗死、再次血管重建事件，并进行冠状动脉造影复查。328例中，ST段抬高的急性心肌梗死66例，非ST段抬高的急性心肌梗死21例，不稳定心绞痛149例，稳定型心绞痛92例。结果 支架植入成功率99．1％（325／328），住院期间无死亡。随访6个月出现急性和亚急性血栓各1例，晚期血栓致心肌梗死2例，心力衰竭死亡1例，进行血管重建术7例。住院其间主要心脏不良事件发生率0．6％（2／328），6个月心脏不良事件发生率3．7％（12／328）。术后6个月84例患者冠状动脉造影复查显示，再狭窄率为8．3％（7／84），支架内为2．4％（2／84），靶病变重建率为5．9％（5／84）。结论 应用Cypher支架治疗老年人冠心病是安全和有效的，主要心脏不良事件发生率低，支架内再狭窄率和靶病变重建率明显低于普通金属支架。     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

目的 以血管内超声评价雷帕霉素洗脱支架置人术后发生支架内再狭窄及血栓形成的机械性危险因素.方法 对雷帕霉素洗脱支架置入术后发生支架内再狭窄或早期(≤30 d)血栓形成的60例患者(事件组)及无支架内再狭窄和早期血栓形成的34例患者(无事件组)的血管内超声资料进行分析比较.结果 事件组发生支架内再狭窄43例,早期血栓形成17例.与无事件组比较,事件组的最小支架面积(MSA)[(4.6±1.6)mm2比(5.8±1.6)mm2,P＜0.01]、最小支架直径[(2.2±0.5)mm比(2.5±0.4)mm,P＜0.01]和支架扩张率[(69.2±20.7)%比(80.6±17.2)%,P＜0.01]较小、纵向支架对称性较差(2.0±0.6比1.7±0.6,P＜0.05).MSA＜4 mm2(43.3%比14.7%,P＜0.01)和支架扩张率＜60%(40.7%比11.8%,P＜0.01)在事件组较常见.与无事件组比较,事件组的近段残余斑块负倚较大[(49.0±15.5)%比(38.4±17.6)%,P＜0.01].Logistic回归分析显示,MSA(OR:0.7,95%CI:0.5～0.8,P＜0.01)和近段残余斑块负荷(OR:280.7,95%CI:17.2～40 583.6,P＜0.01)是药物洗脱支架发生再狭窄或早期血栓形成的独立预测因素.结论 较小的MSA和较重的近段残余病变易导致雷帕霉素洗脱支架发生支架内冉狭窄及早期血栓形成.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.