血管内超声分析重复支架术有或无联合冠脉内放疗对患者支架内再狭窄复发的作用

Effect of Repeat Stenting on Recurrence of Stent Restenosis with or without Intracoronary Radiation Therapy through Intravascular Ultrasound Analysis

目的 系列血管内超声 (IVUS)分析重复支架术 (RS)有或无联合冠脉内的放射治疗 (IRT)对支架内再狭窄 (ISR)患者再狭窄复发的作用。方法 99例 ISR的患者经 RS治疗后随机分为 1 92 Ir放疗组 (n=5 7)和对照组 (n=4 2 ) ,行系列冠脉造影和 IVUS检查 ,分别测量支架、管腔及增生内膜的面积和容积。结果 随访 6月 ,冠脉造影显示放疗组较对照组再狭窄复发率低。两组基线和随访的支架最小面积、平均面积和容积均无变化。两组在随访 6月支架最小腔内面积、平均腔内面积和管腔容积均减小 ,平均增生内膜面积和增生内膜容积均增加 ,但对照组比放疗组的变化更明显。结论 系列 IVUS证实 :IRT抑制新生的内膜形成 ,RS联合 IRT较 RS不联合 IRT更有效减少患者的

Objective Using a serial IVUS,we analyzed recurrence of patients with ISR after RS with or without IRT.Mehtods 99 patients with ISR were first treated with RS and then randomized(blinded) to receive either gramma radiation ( 192 Ir)(n=57) or a placebo(n=42).IVUS were performed immediately after irradiation and at 6 month follow up in patients.Serial stent,lumen and intimal hyperplasia(IH)(stent lumen)were measured.Results Binary angiograpgic restenosis was less in the 192 Ir group compared w ith placebo group at follow up.Stent area and volume were similar immediately after irradiation and follow up in both groups.However,the decrease in minimal lumen area and lumen volume and the increase in mean IH area and IH volume were less in 192 Ir patients compared with placebo patients.Conclusion By inhibiting neointimal hyperplasia within the stent,RS with IRT is effective in reduct ing the recurrence of ISR compared to RS without IRT.