冠状动脉内超声评价支架再狭窄

The process of in-stent restenosis evaluated by intravascular ultrasound

目的 探讨冠状动脉内支架再狭窄的机制。方法 5 0例确诊冠心病患者接受 6 5个支架置入术 ,10个月后复查冠状动脉造影和血管内超声成像检查。根据冠状动脉造影结果将患者分为支架再狭窄组 (2 6个支架 )和无支架再狭窄组 (39个支架 ) ,分别对其冠状动脉造影和血管内超声进行定量测量分析。同时观察支架内再狭窄的方式。结果 血管内超声定量测量发现支架再狭窄组最小血管内膜腔面积和支架最小截面积 [分别为 (2 .5± 1.2 )mm2 和 (4.2± 1.8)mm2 ]明显小于无支架再狭窄组 [分别为 (5 .2± 1.4)mm2 和 (6 .8± 1.7)mm2 ](P分别 <0 .0 0 1和 <0 .0 1) ,但两组新生内膜截面积比较差异无显著性 [分别为 (1.7± 1.0 )mm2 和 (1.5± 0 .9)mm2 ,P >0 .0 5 ]。支架内再狭窄以局灶性狭窄为多见 (6 9.2 % )。结论 支架扩张程度是决定支架内再狭窄的重要因素 ,而支架内内膜增生并不明显。支架内再狭窄以局灶性狭窄为多见。

Objective The purpose of this study was to assess the in stent restenotic process by intravascular ultrasound. Method Fifty patients with 65 stents underwent intravascular ultrasound imaging at the time of 10 months after implantation. There were of 26 stents with and 39 stents without in stent restenosis. The lumen and intimal hyperplasia cross sectional areas (CSA) within the stents were measured by intravascular ultrasound. Pattern of in stent restenosis were then identified. Results Restenotic stents had smaller minimal lumen CSA [(2.5±1.2) mm 2 vs(5.2±1.4) mm 2 P <0.001)]and minimal stent CSA[(4.2±1.8) mm 2 vs.(6.8±1.7) mm 2, P <0.01)] than those of nonrestenotic stents. But intimal hyperplasia had no significant difference between restenotic and nonrestenotic stents[(1.7±1.0) mm 2 vs(1.5±0.9) mm 2 P =0.65)]. The stent restenosis was more commonly focal in nature 69.2%. Conclusion The degree of stent dilation was important in the development of in stent restenosis. But the intimal hyperplasia had no significant difference between restenotic and non restenotic stents in this study.