冠状动脉介入治疗后造影复查支架再狭窄结果分析

Angiographic Analysis for In-Stent Restenosis After Intracoronary Interventional Therapy

目的:分析不同类型支架置入术后冠状动脉(冠脉)造影复查的影像学特点。方法:入选行冠脉介入治疗后进行造影复查的577例患者的846处病变,根据置入支架类型及方式不同分别分析其临床资料及冠脉造影资料。结果:冠脉造影随访率为22.62%;药物支架虽然病变更复杂,但其冠脉造影复查再狭窄率明显低于裸支架(20.29%vs 42.56%,P=0.000);裸支架重叠、药物支架重叠、裸支架与药物支架重叠时再狭窄率分别为53.49%,25.55%,35.29%。药物支架在支架内弥漫性、支架内弥漫性累及两端及支架内局限性再狭窄率明显低于裸支架,差异均有统计学意义(P=0.001,P=0.013,P=0.031),药物支架支架近端局限性再狭窄率高于裸支架,差异有统计学意义(P=0.000);不同药物支架冠脉造影复查再狭窄率没有统计学差异(P=0.193);药物支架和裸支架在糖尿病患者中冠脉造影复查再狭窄率为23.85%和42.65%(P=0.012)。结论:①长病变需要重叠支架时尽量使用药物支架重叠;②药物支架改变了支架再狭窄类型,由弥漫型再狭窄转为局限型;③不同种类药物支架效果良好;④药物支架对糖尿病患者同样有效。

Objective： To evaluate the features of in-stent restenosis（ISR） after implanting different kinds of stents. Methods： A total of 577 patients with 846 lesions who performed coronary artery interventional therapy and had angiographic follow-up were included in this study. The clinical outcomes and angiographic results were analyzed according to different stents respectively. Results： The angiographic follow up rate was 22. 62%. The ISR rate in drug eluting stent（DES） was lower than that in bare metal stent（BMS） as 20. 29% vs 42. 56% （P =0. 000）. When overlapping stents were used in long lesion,the ISR rate for BMS overlapping was 53.49% ,for DES overlapping was 25.55%, for BMS and DES overlapping was 35.29%. In DES, the iu-stent diffused restenosis,the restenosis involved in both sides and the focal restenosis were all lower than in BMS（ P = 0. 001, P = 0. 013 ,P =0. 031 respectively）. In DES,the focal proximal edge restenosis was higher than in BMS（ P = 0. 000）. There was no significant statistic difference among different kinds of DES（P =0. 193 ）. DES was effective in diabetes patients,based on angiographic follow up,the restenosis of DES and BMS in diabetes patients was 23.85% vs 42. 65% （P =0. 012）. Conclusion： DES overlapping was better in long lesion; DES changed the ISR morphology from diffused lesion to focal lesion; different kinds of DES had good effect and was effective for patients with diabetes.