左塔罗莫司和雷帕霉素涂层支架置入后血管愈合反应的血管内超声研究

目的探讨左塔罗莫司涂层支架（zotarolimus-eluting stent,ZES）和雷帕霉素涂层支架（sirolimus-eluting stent,SES）置入术后血管愈合情况。方法不稳定性心绞痛患者86例,根据置入支架分为ZES组36例和SES组50例,ZES组经桡动脉置入ZES,SES组经桡动脉置入SES。2组均随访（11.3±1.8）个月,于支架置入前、置入即刻及随访时行血管内超声检查,比较病变节段斑块体积、管腔体积、外弹力膜体积及斑块脱垂和支架贴壁不良发生情况。结果 2组支架置入前、置入即刻及随访时病变节段管腔体积、外弹力膜体积差异无统计学意义（P〉0.05）;SES组随访时外弹力膜体积（（431.7±92.2）mm3）明显大于支架置入前（（399.2±61.2）mm3）（P〈0.05）,ZES组（（401.4±81.3）mm3）与支架置入前（（392.6±72.0）mm3）比较差异无统计学意义（P〉0.05）;ZES组支架置入即刻斑块脱垂率和随访时支架贴壁不良发生率（22.2%,2.9%）明显低于SES组（44.0%,18.0%）（P〈0.05）;SES置入（OR=4.175,95%CI：1.352-11.978,P=0.005）和斑块脱垂（OR=1.438,95%CI：1.016-1.702,P=0.029）是晚期支架贴壁不良的独立预测因素。结论与SES比较,ZES置入后斑块脱垂和晚期支架贴壁不良发生率明显减少,SES置入和斑块脱垂是晚期支架贴壁不良的独立预测因子。

Intravascular ultrasound study on vascular response to zotarolimus-eluting stent versus sirolimus-eluting stent

Objective To investigate the vascular response of zatarolimus-eluting stent （ZES） and sirolimus-eluting stent （SES） using serial intravaseular ultrasound （IVUS）. Methods Eighty-six patients with unstable angina pectoris were divided into ZES group （n = 36） and SES group （n = 50）, receiving ZES and SES implantation via radial artery respectively. Both two groups were followed up for （11. 3 ±1. 8） months. IVUS was performed before and after intervention as well as during follow-up to compare the plaque volume, lumen volume and external elastic membrane volume, plaque prolapse and stent malapposition. Results There were no significant differences in the pre- and post- implantation, and in follow-up plaque volume, lumen volume and external elastic membrane volume at lesion segment （P〉0. 05）. The follow-up external elastic membrane volume （（431. 7±92. 2） mma） was larger than that of pre- implantation （（399. 2±61.2） mm3） （P〈0.05）, and there was no significant difference between follow-up external elastic membrane volume （（401.4±81.3） mma） and pre-implantation （（392.6±72.0） mma） in ZES group （P〉0.05）. The incidences of plaque prolapse and stent malapposition were significantly lower in ZES group （22.2%, 2. 9%） than those in SES group （44.0 %, 18.0 %） when implantation （P〈0.05）. Multivariable regression analysis showed that SES implantation （OR=4.175, 95%,CI： 1.352 to 11. 978, P=0.005） and plaque prolapse （OR=1.438, 95%CI： 1.016 to 1. 702, P= 0. 029） were the independent predictors of late stent malapposition. Conclusion Compared with SES implantation, the incidences of plaque prolapse and late stent malapposition decrease after ZES implantation. Plaque prolapse and late stent malapposition are the independent predictors of late stent malapposition.