应用冠脉血管内超声评价药物涂层支架置放后再狭窄及血管内膜增生  

Evaluation of the coronary in-stent restenosis and neointimal hyperplasia between two kinds of drug eluting stent implantation under intravenous ultrasound

作　　者：曹晶茗[1] 肖践明[1] 刘中梅[1] 刘蓉[1] 蔡红雁[1] 张云红[1] 许峰[1] 郭涛[1] 韩明华[1] 

机构地区：[1]昆明医学院第一附属医院心内科,650032

出　　处：《介入放射学杂志》2007年第10期657-660,共4页Journal of Interventional Radiology

基　　金：云南省科技厅自然科技资助合同项目

摘　　要：目的应用冠脉内超声测量支架置入6个月后内膜增生厚度,准确比较不同支架再狭窄率。方法选择57例药物洗脱支架(DES)置入术后4～8(6±2)个月同意复查冠脉造影及冠脉血管内超声的冠心病(CHD)住院患者,分为Cypher支架组(25例)和Firebird支架组(32例),及同期491例植入金属裸支架(BMS)CHD患者,测量支架置入后6个月时的内膜增生并进行比较。结果冠脉造影显示DES发生再狭窄Cypher组11例,Firebird组10例,裸支架组25例。再狭窄率分别为8.4%,8.9%和10.0%。DES两组差异无统计学意义,裸支架组与Cypher组及Firebird组相比较差异有显著性。冠脉内超声检查结果显示DES组中Cypher支架新生内膜面积为(1.11±0.89)mm2,支架再狭窄率(9.0±0.1)%;Firebird组为(1.13±0.08)mm2,支架再狭窄率(10.0±0.2)%。DES两组间比较差异无统计学意义。裸支架组支架新生内膜面积为(1.44±0.04)mm2,再狭窄率为(21.0±0.1)%,与DES两组比较,有显著的统计学差异(P<0.05)。支架两端的节段狭窄率DES组中近端的节段狭窄Cypher组(0.43±0.25)%与Firebird组(0.40±0.15)%都显著高于裸金属支架组(0.29±0.13)%(P<0.05)。远端的节段狭窄率,三组比较差异无统计学意义。结论应用冠脉内超声评价支架内再狭窄准确度优于冠脉造影。DES降低支架内再狭窄率明显优于裸金属支架,防止支架节段狭窄,裸金属支架可能有优势。Objective To compare two kinds of drug eluting stent implantation for in-stent restenosis through surveying coronary arterial neointima hyperplasia thickness after 6 month by intravenous ultrasound. Methods Fifty seven volunteers taking part in IVUS form serious 242 DES patiens （Drug Eluting Stent）with implantation 6 months during January 2005 to December 2006 vs. 49 volunteers from 251 BMS （Bare Metal Stent）patients as the contrast were surveyed and compared for neointima hyperplasia thickness. Results Neointima hyperplasic area： Cypher group 1.11 ± 0.89 mm^2, vs. Firebird group 1.13 ± 0.08 mm^2, and stent restenosis rate： Cypher group （9.0 ± 0.1 ）%, vs. Firebird group （10.0 ± 0.2）%; revealed no significant difference between the two groups. DES groups with BMS showed the neointima hyperplasic area as 1.44 ± 0.04 mm^2, stent restenosis rate as（21.0 ± 0.1）%, P 〈 0.05, the difference is significant. Stent segment stenosis in the distal parts showed no difference between DES and BMS groups. The proximal parts of stent stenosis showed as BMS group （0.29 ± 0.13）% vs. Cypher group （0.43 ± 0.25）% Firebird group （0.40 ± 0.15）% outcoming with P 〈 0.05 ; the differences were significant. Conclusion DES stent is superior to BMS stent in preventing in-stent restenosis and BMS is probably superior to DES in preventing stent segment restenosis.IVUS survey is more preeise than coronary angiography.

关 键 词：冠状动脉疾病 支架 再狭窄 冠脉内超声 

分 类 号：R541.4[医药卫生—心血管疾病]