Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis
Simple balloon dilation for drug-eluting in-stent restenosis: An optical coherent tomography analysis
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DOI：
10.1016/j.carrev.2014.11.002
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发表时间：
2015-01-01
影响因子：
1.7
通讯作者：
Kaneda, Hideaki
中科院分区：
文献类型：
--
作者：
Arikawa, Ryo;Yamaguchi, Hiroshi;Kaneda, Hideaki
背景：尽管药物洗脱支架（DES）显著减少了再狭窄，但由于DES支架再狭窄率高，其治疗仍然是一个挑战。方法：我们通过光学相干断层扫描（OCT）检查再狭窄组织的形态外观是否对DES-ISR球囊血管成形术后的结果有影响。再狭窄组织的形态学外观定性评估组织结构，如均匀、分层和非均匀模式。结果：采用OCT将50例des - isr患者分为2组：均质或层状病变25例（同质/层状组）和异质性病变25例（异质组）。急性增益在异性组更大（1.33 +/- 0.41mmvs）。1.06 +/- 0.32 min为人/层组，P = 0.03)。在血管内超声分析中，异性组术后新生内膜面积百分比更小（27.4 +/- 9.2% vs. 34.0 +/- 11.2%, P = 0.05）。37例（74%）病变行血管造影随访。异性组随访最小管腔直径更大（1.75 +/- 0.89 mm vs.同质/分层组1.01 +/- 0.81 mm, P = 0.04）。异种组靶病变血运重建率较低（20% vs.人/层组43%，P = 0.12）。结论：对于组织形态不均匀的des - isr，球囊血管成形术比组织形态均匀/分层的DESISR更有效。OCT评估DES-ISR形态学可能是确定临床策略的有用辅助。单纯球囊扩张是一种可能的治疗策略，用于DES-ISR病变在OCT图像上的异质外观。(C) 2014爱思唯尔公司版权所有。
Background: Although drug-eluting stent (DES) has significantly reduced restenosis, the treatment of DES-instent restenosis (ISR) remains a challenge with high restenosis rate.Methods: We examined whether morphologic appearance of restenosis tissue by optical coherent tomography (OCT) had an impact on outcomes after balloon angioplasty for DES-ISR. The morphologic appearance of restenosis tissue was qualitatively assessed for tissue structures such as homogeneous, layered, and heterogeneous patterns.Results: Using OCT, 50 patientswith DES-ISRwere divided into 2 groups: 25 lesionswith homogeneous or layered patterns (homo/layered group) and 25 lesionswith heterogeneous patterns (hetero group). Acute gainwas larger in the hetero group (1.33 +/- 0.41mmvs. 1.06 +/- 0.32mmin the homo/layered group, P = 0.03). On intravascular ultrasound analysis, post-procedural percent neointimal area was smaller in the hetero group (27.4 +/- 9.2% vs. 34.0 +/- 11.2% in the homo/layered group, P = 0.05). Angiographic follow-up was performed in 37 lesions (74%). Follow-up minimal lumen diameter was larger in the hetero group (1.75 +/- 0.89 mm vs. 1.01 +/- 0.81 mm in the homo/layered group, P = 0.04). Target lesion revascularization rates tended to be lower in the hetero group (20% vs. 43% in the homo/layered group, P = 0.12).Conclusions: Balloon angioplastywas more effective for DES-ISRwith heterogeneous tissue appearance than DESISR with homogeneous/layered tissue appearance. OCT assessment of DES-ISR morphology may be a useful adjunct in determining clinical strategies. Simple balloon dilatation is a possible treatment strategy for DES-ISR lesions with a heterogeneous appearance on OCT images. (C) 2014 Elsevier Inc. All rights reserved.