Pathological correlates of late drug-eluting stent thrombosis - Strut coverage as a marker of endothelialization
Pathological correlates of late drug-eluting stent thrombosis - Strut coverage as a marker of endothelialization
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DOI：
10.1161/circulationaha.107.693739
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发表时间：
2007-05-08
期刊：
影响因子：
37.8
通讯作者：
Virmani, Renu
中科院分区：
文献类型：
--
作者：
Finn, Aloke V.;Joner, Michael;Virmani, Renu
背景-Cypher和Taxus药物洗脱支架置入后的晚期支架血栓形成（LST）已成为一个主要问题。虽然LST的临床预测因素已被报道，但LST的具体形态学和组织学相关性仍不清楚。方法和结果-从一项登记研究中，共有81例药物洗脱支架的人体尸检，46例（62处病变）植入药物洗脱支架超过30天。我们确定了28个有血栓的病变，并使用计算机引导的形态学和组织学分析将其与34个相似持续时间的无血栓病变进行了比较。LST被定义为冠状动脉支架内的急性血栓> 30天。多元Logistic广义估计方程模型显示，内皮化是血栓形成的最佳预测因子。与内皮化最相关的形态学参数是每个切片的未覆盖支架支柱与总支架支柱的比值。支架节段血栓发生率与每节段未覆盖支架支柱与总支架支柱比率的单变量logistic广义估计方程模型表明，随着未覆盖支柱数量的增加，LST的风险显著增加。每节段未覆盖支架支柱与总支架支柱之比> 30%的支架中血栓的比值比为9.0（95% CI，3.5 - 22）。结论：支架血栓形成最有力的组织学预测因子是内皮覆盖. LST的最佳形态学预测因子是未覆盖支架支柱与总支架支柱的比值。愈合异质性是具有LST证据的药物洗脱支架中的常见发现，并证明了支架植入节段的不完全愈合在LST病理生理学中的重要性。
Background - Late stent thrombosis (LST) after Cypher and Taxus drug-eluting stent placement has emerged as a major concern. Although the clinical predictors of LST have been reported, specific morphological and histological correlates of LST remain unknown. Methods and Results - From a registry totaling 81 human autopsies of drug-eluting stents, 46 (62 lesions) had a drug-eluting stent implanted > 30 days. We identified 28 lesions with thrombus and compared those with 34 of similar duration without thrombosis using computer-guided morphometric and histological analyses. LST was defined as an acute thrombus within a coronary artery stent in place > 30 days. Multiple logistic generalized estimating equations modeling demonstrated that endothelialization was the best predictor of thrombosis. The morphometric parameter that best correlated with endothelialization was the ratio of uncovered to total stent struts per section. A univariable logistic generalized estimating equations model of occurrence of thrombus in a stent section versus ratio of uncovered to total stent struts per section demonstrated a marked increase in risk for LST as the number of uncovered struts increased. The odds ratio for thrombus in a stent with a ratio of uncovered to total stent struts per section > 30% is 9.0 (95% CI, 3.5 to 22). Conclusions - The most powerful histological predictor of stent thrombosis was endothelial coverage. The best morphometric predictor of LST was the ratio of uncovered to total stent struts. Heterogeneity of healing is a common finding in drug-eluting stents with evidence of LST and demonstrates the importance of incomplete healing of the stented segment in the pathophysiology of LST.