Impacts of lesion angle on incidence and distribution of acute vessel wall injuries and strut malapposition after drug-eluting stent implantation assessed by optical coherence tomography
Impacts of lesion angle on incidence and distribution of acute vessel wall injuries and strut malapposition after drug-eluting stent implantation assessed by optical coherence tomography
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光学相干断层扫描评估病变角度对药物洗脱支架植入后急性血管壁损伤和支架贴壁不良发生率和分布的影响
DOI：
10.1093/ehjci/jev108
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发表时间：
2015
期刊：
影响因子：
--
通讯作者：
Uemura S et al
中科院分区：
文献类型：
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作者：
Minami Y;Uemura S et al
目的利用光学相干断层扫描（OCT）研究病变角度对第二代药物洗脱支架（DES）植入术后急性血管壁损伤和支架不完全贴置（ISA）发生率和分布的影响。几项体内研究表明，倾斜的动脉壁暴露在部署支架的不平衡机械应力下。方法和结果我们纳入了243例使用单一DES治疗的病变（148例依维莫司洗脱支架和95例佐他莫司洗脱支架）。角度病变定义为血管造影上角度≥45°的病变（n= 58）。用oct评估血管壁损伤和ISA，结果与无角度病变（<45°，n= 185）进行比较。夹角组的支架夹层、血栓、ISA发生率明显高于非夹角组（84.5%比63.2%，P< 0.01； 55.2比35.1%，P< 0.01； 75.9比44.9%，P< 0.001）。成角组在角中心周围的标准化组织突出体积（6.59±6.81,mm3× 102）高于远端亚段（2.21±2.87,mm3× 102，P< 0.001）、近端亚段（4.14±5.34,mm3× 102，P= 0.02）和非成角组（3.30±2.81,mm3× 102，P< 0.001）。12个月内主要心脏不良事件的发生率在两组之间相似。结论与无角度冠状动脉病变相比，第二代DES植入后，冠状动脉病变的oct检测血管壁损伤和ISA发生率更高。需要进一步的研究来了解这些发现的长期临床意义。
AimsTo investigate the impact of lesion angle on the incidence and distribution of acute vessel wall injuries and incomplete stent apposition (ISA) following second-generation drug-eluting stent (DES) implantation using optical coherence tomography (OCT). Severalex vivostudies demonstrated that angled arterial walls are exposed to imbalanced mechanical stress from deployed stents.Methods and resultsWe included 243 lesions treated with a single DES (148 everolimus-eluting stent and 95 zotarolimus-eluting stent). Angled lesions were defined as lesions with angle ≥45° on an angiogram (n= 58). The vessel wall injuries and ISA were evaluated by OCT. The results were compared with non-angled lesions (<45°,n= 185). The incidence of instent dissection, thrombus, and ISA was significantly higher in the angled group than in the non-angled group (84.5 vs. 63.2%,P< 0.01; 55.2 vs. 35.1%,P< 0.01; 75.9 vs. 44.9%,P< 0.001, respectively). In the angled group, the normalized tissue protrusion volume around the centre of angle (6.59 ± 6.81, mm3× 102) was higher than in the distal sub-segment (2.21 ± 2.87, mm3× 102,P< 0.001), in the proximal sub-segment (4.14 ± 5.34, mm3× 102,P= 0.02), and in the non-angled group (3.30 ± 2.81, mm3× 102,P< 0.001). The incidence of major adverse cardiac events within 12 months was similar between the groups.ConclusionsAngled coronary lesions had a higher incidence rate of OCT-detected vessel wall injuries and ISA compared with non-angled lesions following second-generation DES implantation. Further studies are needed to understand the long-term clinical significance of these findings.