Restenosis of a drug eluting stent on the previous bioresorbable vascular scaffold successfully treated with a drug-coated balloon: A case report

BACKGROUND The in-stent restenosis(ISR)rates are reportedly inconsistent despite the increased use of second-generation drug eluting stent(DES).Although bioresorbable vascular scaffold(BVS)have substantial advantages with respect to vascular restoration,the rate of scaffold thrombosis is higher with BVS than with DES.Optimal treatment strategies have not been established for DES-ISR to date.CASE SUMMARY We report on a case of a 60-year-old man patient with acute coronary syndrome.He had a history of ST-segment elevation myocardial infarction associated with very late scaffold thrombosis and treated with a DES.Coronary angiography revealed significant stenosis,suggesting DES-ISR on the previous BVS.Optical coherence tomography(OCT)identified a plaque rupture and a disrupted scaffold strut in the neointimal proliferation of DES.To treat the DES-ISR on the previous BVS,we opted for a drug-coated balloon(DCB)after a balloon angioplasty using a semi-compliant and non-compliant balloon.The patient did not experience adverse cardiovascular events on using a DCB following the use of intensive dual antiplatelet therapy and statin for 24 mo.CONCLUSION This case highlights the importance of OCT as an imaging modality for characterizing the mechanism of target lesion failure.The use of a DCB following the administration of optimal pharmacologic therapy may be an optimal strategy for the treatment and prevention of recurrent BVS thrombosis and DES-ISR.

解毒活血方对经皮冠状动脉介入术后患者NF-κB、IL-1β、TNF-α变化及支架内再狭窄的影响

【目的】观察解毒活血方干预经皮冠状动脉介入(PCI)术后患者外周血中核因子kappaB(NF-κB)、白细胞介素-1β(IL-1β)、肿瘤坏死因子-α(TNF-α)的变化及支架内再狭窄(ISR)的发生情况,以期阐明解毒活血方防治ISR的远期疗效及机制。【方法】选择符合PCI术后纳入标准的患者40例,将PCI术后给予基础治疗者设为对照组,将PCI术后给予基础治疗+解毒活血方治疗者设为中药组,每组各20例。治疗结束后,观察2组临床疗效。于PCI术前及术后24 h、14 d,采用流式细胞仪检测2组患者外周血单个核细胞NF-κB活性,采用酶联免疫吸附法(ELISA)检测2组患者血浆IL-1β及TNF-α表达水平。观察患者术后6个月内心血管事件及ISR的发生情况。【结果】中药组患者的临床疗效显著优于对照组(P<0.05),证候积分及PCI术后6个月内心血管事件和ISR的发生率显著低于对照组(P<0.05或P<0.01)。2组患者PCI术后24 h NF-κB阳性表达率及TNF-α、IL-1β表达水平较治疗前显著升高(P<0.01),但2组差异无统计学意义(P>0.05);2组患者PCI术后14 d NF-κB阳性表达率及TNF-α、IL-1β表达水平较术后24 h显著降低(P<0.01),且中药组降低效果明显优于对照组(P<0.05)。【结论】解毒活血方可降低ISR的发生率,其机制可能与降低NF-κB活性及血浆IL-1β、TNF-α表达水平有关。

莪术油对动脉损伤大鼠血管成形术后再狭窄的抑制作用

【目的】探讨莪术油对血管成形术后再狭窄的防治作用。【方法】建立大鼠颈动脉球囊导管损伤模型,采用计算机图像分析再狭窄病灶的形态学和组织学变化,对假手术组、莪术油组和模型组共25只大鼠进行研究。【结果】术后 14d,模型组出现血管内膜增厚及新生内膜面积增大,管腔面积和内、外弹力板周长缩小,与假手术组比较有非常显著性差异(P<0.01);莪术油组最大内膜厚度及新生内膜面积比模型组减少,而管腔面积和内、外弹力板周长增加(P<0.01);与假手术组比无显著性差异(P>0.05)。【结论】莪术油可抑制大鼠损伤动脉内膜增生和血管重构,有防治血管成形术后再狭窄作用。