| Intravascular ultrasound assessment of the incidence and predictors of edge dissections and intramural hematomas after drug-eluting stent implantation |
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| 引用本文： | Gary S．Mintz,Stéphane G．Carlier,Jose de Ribamar Costa Jr,Koichi Sano,Joanna Lui,Giora Weisz,Issam Moussa,George D．Dangas,Roxana Mehran,Edward M．Kreps,Michael Collins,Gregg W．Stone,Jeffrey W．Moses,GE Junbo,Martin B．Leon. Intravascular ultrasound assessment of the incidence and predictors of edge dissections and intramural hematomas after drug-eluting stent implantation[J]. 上海医学, 2007, 30(Z1) |
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| 作者姓名： | Gary S．Mintz Stéphane G．Carlier Jose de Ribamar Costa Jr Koichi Sano Joanna Lui Giora Weisz Issam Moussa George D．Dangas Roxana Mehran Edward M．Kreps Michael Collins Gregg W．Stone Jeffrey W．Moses GE Junbo Martin B．Leon |
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| 作者单位： | Department of Cardiology Zhongshan Hospital，Fudan University，Shanghai 200032，China，Columbia University Medical Center and Cardiovascular Research Foundation New York，USA． |
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| 摘 要： | Objective We used intravascular ultrasound (IVUS) to assess incidence, predictors, morphology, and angiographic findings of edge dissections and intramural hematomas after drug-eluting stent (DES) implantation. Methods We studied 887 patients with 1 045 non-in-stent restenosis lesions in 977 native arteries undergoing DES implantation with IVUS imaging, and compared the dissected stent end to the non-dissected stent end. Results Eighty-two dissections were detected; 51.2% (42/82) involved the proximal and 48.8% (40/82) the distal stent edge. When compared to the non-dissected stent end, residual plaque area [(8.0±4.3) mm2 vs (5.2±3.0) mm2, P<0.01], plaque burden [(52±12)% vs (36±15)%, P<0.01], plaque eccentricity (8.4±5.5 vs 4.0±3.4, P<0.01), and stent edge symmetry (1.17±0.11 vs 1.14±0.08, P=0.02) were larger; plaque burden≥50% was more frequent (62% vs 17%, P<0.01) and calcium deposits (52.5% vs 35.6%, P=0.03) more common; and the lumen/stent area (0.86±0.16 vs 1.02±0.18, P<0.01) was smaller in the stent dissected end. Independent predictors of stent edge dissection were residual plaque eccentricity (OR=1.3, P<0.01) and residual plaque burden≥50% (OR=7.3, P<0.01). Intramural hematomas occurred in 34.1% (28/82) of dissections.Independent predictors of intramural hematomas were plaque eccentricity (OR=1.4, P=0.005), plaque burden≥50% (OR=7.1, P=0.02), and mean lumen diameter to stent diameter ratio (OR=0.37, P=0.04).Concluslon IVUS identified edge dissections after 9.4% of DES implantations. Residual plaque eccentricity and significant plaque burden predicted coronary stent edge dissections. Dissections in less diseased reference segments with an arc of normal vessel wall (greater plaque eccentricity) more often evolved into an intramural hematoma.
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Intravascular ultrasound assessment of the incidence and predictors of edge dissections and intramural hematomas after drug-eluting stent implantation |
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