范春雨,Kim Jung-Sun,Kim Tae-Hoon,吕吉元

• 1:山西医科大学第一医院心内科
• 2:韩国延世大学severance医院心血管中心

摘要(Abstract)：

目的应用光学相干断层成像(OCT)比较急性心肌梗死(AMI)患者植入不同药物洗脱支架(DES)后的新生内膜覆盖和支架贴壁情况以评估血管愈合。方法 49例AMI患者植入不同DES后9个月时进行OCT检查。其中20个雷帕霉素药物洗脱支架(SES,Cypher),12个紫杉醇药物洗脱支架(PES,Taxus)和17个雷帕霉素衍生物药物洗脱支架(ZES,Endeavor)。每隔1mm评估OCT横断面影像每个支架柱的新生内膜覆盖和贴壁情况,同时观察每个支架内的血栓发生情况。结果总计对12378个支架柱进行了分析。SES的新生内膜增生最少,新生内膜厚度:SES(77±60)μm、PES(153±82)μm、ZES(265±130)μm,且新生内膜增生面积百分比最低,SES(10±8)%、PES(19±8)%、ZES(28±9)%,但SES和PES有更多未被新生内膜覆盖的支架柱,SES(15.1±16)%、PES(7.1±10)%、ZES(0.6±1.5)%,且贴壁不良支架柱的发生率也高于ZES,SES(3.8±7.2)%、PES(2.1±4.4)%、ZES(0±0)%,而有完全新生内膜覆盖的支架比例以ZES为高,SES5%、PES33.3%、ZES82.4%。血栓的发生率SES和PES高于ZES,SES34%、PES33%、ZES6%。结论 AMI患者植入不同类型DES后,其支架的新生内膜覆盖程度和贴壁不良的发生率是显著不同的,因此DES的类型可能影响了AMI血栓性病变的血管愈合过程。

关键词(KeyWords)： 心肌梗死;体层摄影术,光学相干;药物洗脱支架

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 范春雨,Kim Jung-Sun,Kim Tae-Hoon,吕吉元

参考文献(References)：

• [1]Joner M,Finn AV,Farb A,et al.Pathology of drug-eluting stents in humans:delayed healing and late thrombotic risk.J Am Coll Cardiol,2006,48:193-202.
• [2]Nakazawa G,Finn AV,Joner M,et al.Delayed arterial healing and increased late stent thrombosis at culprit sitesafter drug-eluting stent placement for acute myocardial infarction patients:an autopsy study.Circulation,2008,118:1138-1145.
• [3]Matsumoto D,Shite J,Shinke T,et al.Neointimal coverage of sirolimus-eluting stents at6-month follow-up:evaluated by optical coherence tomography.Eur Heart J,2007,28:961-967.
• [4]Yao ZH,Matsubara T,Inada T,et al.Neointimal coverage of sirolimus-eluting stents6months and12months after implantation:evaluation by optical coherence tomography.Chin Med J,2008,121:503-507.
• [5]Takano M,Yamamoto M,Inami S,et al.Long-term follow-up evaluation after sirolimus-eluting stent implantation by optical coherence tomography.J Am Coll Cardiol,2008,51:968-969.
• [6]Takano M,Inami S,Jang IK,etal.Evaluation by optical coherence tomography of neointimal coverage of sirolimus-eluting stent three months after implantation.Am J Cardiol,2007,99:1033-1038.
• [7]Guagliumi G,Sirbu V.Optical coherence tomography:high resolution intravascular imaging to evaluate vascular healing after coronary stenting.Catheterizat Cardiovasc Int,2008,72:237-247.
• [8]Tanigawa J,Barlis P,Di Mario C.Intravascular optical coherence tomography:optimisation of image acquisition and quantitative assessment of stent strut apposition.Euro Interv,2007,3:128-136.
• [9]Tanigawa J,Barlis P,Dimopoulos K,et al.The influence of strut thickness and cell design on immediate apposition of drug-eluting stents assessed by optical coherence tomography.Int J Cardiol,2009,134:180-188.
• [10]Kume T,Akasaka T,Kawamoto T,et al.Assessment of coronary arterial thrombus by optical coherence tomography.Am J Cardiol,2006,97:1713-1717.
• [11]Finn AV,Joner M,Nakazawa G,et al.Pathological correlates of late drug-eluting stent thrombosis:strut coverage as a marker of endothelialization.Circulation,2007,115:2435-2441.
• [12]Gonzalo N,Barlis P,Serruys PW,et al.Incomplete stent apposition and delayed tissue coverage are more frequent in Drug-Eluting Stents implanted during primary percutaneous coronary intervention for ST-Segment Elevation Myocardial Infarction than in Drug-Eluting Stents implanted for stable/unstable angina:insights from optical coherence tomography.J Am Coll Cardiol Intv,2009,2:445-452.
• [13]Levin AD,Vukmirovic N,Hwang CW,et al.Specific binding to intracellular proteins determines arterial transport properties for rapamycin and paclitaxel.Proc Natl Acad Sci US A,2004;101:9463-9467.
• [14]Hwang CW,Levin AD,Jonas M,et al.Thrombosis modulates arterial drug distribution for drug-eluting stents.Circulation,2005,111:1619-1626.
• [15]Finn AV,Nakazawa G,Joner M,et al.Vascular Responses to Drug Eluting Stents:Importance of Delayed Healing.Arterioscler Thromb Vasc Biol,2007;27:1500-1510.
• [16]Meredith IT,Ormiston J,Whitbourn R,et al.ENDEAVOR I Investigators.Four-year clinical follow-up after implantation of the endeavor zotarolimus-eluting stent:ENDEAVOR I,the first-in-human study.Am J Cardiol,2007,100:56M-61M.
• [17]Kandzari DE,Leon MB,Popma JJ,et al.Comparison of zotarolimuseluting and sirolimus-eluting stents in patients with native coronary artery disease:a randomized controlled trial.J Am Coll Cardiol,2006,48:2440-2447.