Effect of strut thickness on neointimal atherosclerotic change over an extended follow-up period (≥4 years) after bare-metal stent implantation: Intracoronary optical coherence tomography examination
Effect of strut thickness on neointimal atherosclerotic change over an extended follow-up period (≥4 years) after bare-metal stent implantation: Intracoronary optical coherence tomography examination
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DOI：
10.1016/j.ahj.2012.01.007
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发表时间：
2012-04-01
影响因子：
4.8
通讯作者：
Akasaka, Takashi
中科院分区：
文献类型：
--
作者：
Kitabata, Hironori;Kubo, Takashi;Akasaka, Takashi
背景 由于对金属的持续炎症反应，裸金属支架 (BMS) 内的新内膜在长期随访过程中可能会转化为动脉粥样硬化组织。我们试图利用光学相干断层扫描研究支架厚度是否会影响 BMS 植入后 4 年或更长时间的新内膜动脉粥样硬化变化。方法 41 名 BMS 植入后≥4 年患者的 46 个支架病变接受了光学相干断层扫描纳入本研究。当小于100μm时，支柱被定义为薄的；当≥100μm时，支柱被定义为厚的。根据这些标准，支架分为 2 组（薄支柱 n = 19，厚支柱 n = 27）。新内膜组织分为正常新内膜，其特征是信号丰富的带，没有信号衰减，或充满脂质的内膜，具有明显的信号衰减和弥漫性边界。还评估了内膜破裂、血栓和新生血管形成。结果 薄支柱组植入后的平均时间为 98.2 +/- 25.8 个月，粗支柱组为 91.1 +/- 22.8 个月 (P = .330)。厚支柱组比薄支柱组更频繁地观察到充满脂质的内膜（70% vs 32%，P = .016）、薄帽纤维粥样斑样内膜（59% vs 16%，P = .0056）和内膜破裂（48% vs 16%，P = .031），但在发生频率方面没有观察到显着差异。血栓。尽管支架周围新生血管形成在两组中都很常见（厚支架与薄支架组分别为 81% vs 79%，P = 1.000），但厚支架组内膜内新生血管的频率往往更高（67% vs 42%，P = 0.135）。 结论 较薄的支架厚度可能对 BMS 植入后的新生内膜动脉粥样硬化变化产生有利影响。 （Am Heart J 2012；163：608-16。）
Background Neointima inside the bare-metal stents (BMSs) can transform into atherosclerotic tissue during an extended follow-up because of a persistent inflammatory reaction to the metal. We sought to investigate whether strut thickness may impact on the atherosclerotic change in neointima 4 years or more after BMS implantation using optical coherence tomography.Methods Forty-six stented lesions of 41 patients with BMS >= 4 years after implantation who underwent optical coherence tomography were enrolled in the study. The strut was defined as thin when less than 100 mu m and thick when >= 100 mu m. According to these criteria, stents were divided into 2 groups (thin strut n = 19, thick strut n = 27). Neointimal tissue was categorized into normal neointima, characterized by a signal-rich band without signal attenuation, or lipid-laden intima, with marked signal attenuation and a diffuse border. Intimal disruption, thrombus, and neovascularization were also evaluated.Results The mean period after implantation was 98.2 +/- 25.8 months in the thin-strut group and 91.1 +/- 22.8 months in the thick-strut group (P = .330). Lipid-laden intima (70% vs 32%, P = .016), thin-cap fibroatheroma-like intima (59% vs 16%, P = .0056), and intimal disruption (48% vs 16%, P = .031) were observed more frequently in the thick-strut group than in the thin-strut group, but no significant difference was observed in the frequency of thrombus. Although peristrut neovascularization was a common finding in both groups (thick vs thin 81% vs 79%, P = 1.000), the frequency of intraintima neovascularization tended to be higher in the thick-strut group (67% vs 42%, P = .135).Conclusions A thinner strut thickness may have favorable effects on neointimal atherosclerotic changes after BMS implantation. (Am Heart J 2012; 163:608-16.)