药物洗脱支架术后再狭窄八例

Observation of 8 patients with restenosis after drug-eluting stents implantation

目的分析药物洗脱支架术后再狭窄的因素。方法2002年9月至2004年5月,8例经冠状动脉造影证实有药物洗脱支架术后再狭窄的患者入选本研究。所有患者均行血管内超声(IVUS)检查。再狭窄分为支架内再狭窄和节段内再狭窄。支架内再狭窄定义为支架内径狭窄大于50%;节段内再狭窄定义为支架近、远段5mm内血管内径狭窄大于50%。结果8例再狭窄患者中,5例是支架近段再狭窄,3例支架内再狭窄(其中2例是由于支架未充分扩张所致)。支架置入过程中,5例曾行支架外后扩张,1例未完全覆盖病变。IVUS显示,8例均为局灶性狭窄,无一例弥漫性再狭窄。结论药物洗脱支架术后再狭窄主要与支架外血管损伤及未完全覆盖病变有关,且再狭窄主要发生在支架近段。即使发生支架内再狭窄,病变也较局限。

Objective To analyze the factors of restenosis after drug-eluting stents implantation. Methods By means of coronary angiography eight patients were identified to have restenosis after drug-eluting stents implantation between September 2002 and May 2004. All the patients received intravascular ultrasound （IVUS） examination. Restenosis was defined by diameter stenosis 〉 50% and was classified as in-stent if inside stent or in- segment if located within the stented segment plus the 25 mm segments distal or proximal to the stent margins. Results Among the 8 patients included in this analysis, 5 had in-segment restenosis and 3 had in-stent restenosis （2 were not real in-stent restenosis and were just due to underexpansion）. IVUS showed all restenosis occurred as localized lesion. Conclusion Restenosis after drug-eluting stents implantation is frequently associated with local trauma outside the stented segment and incomplete lesion coverage by the drug-eluting stent. Restenosis usually occurs proximal to the stent and presents as a localized lesion.