DES双联抗血小板治疗的现状与未来.pptVIP

OBJECTIVES The goal of this study was to use angioscopy to investigate the amount of neointimal coverage after sirolimus-eluting stent (SES) implantation. BACKGROUND Sirolimus-eluting stents reduce intimal hyperplasia. METHODS We used angioscopy to evaluate 37 consecutive stented coronary artery lesions (15 SES and 22 bare-metal stents [BMS]) in 25 patients (18 men, 7 women) at 3 to 6 months after stent implantation. Angioscopic evaluation focused on: 1) neointimal coverage of stent struts, and 2) the existence of thrombi. The degree of neointimal coverage was classified as grade 0 when there was no neointimal coverage (similar to immediately after the implantation); grade 1 when stent struts bulged into the lumen, but were covered and still translucently visible; grade 2 when stent struts were visible but not clearly seen (not translucent); and grade 3 when stent struts were not visible because they were embedded in the neointima. RESULTS Thrombi were identified in eight stented segments, tended to be more common with SES (p 0.14), but were not seen on angiography. Three of the 15 SES (20%) had grade 0 neointimal coverage, and only 2 SES (13.3%) had complete coverage (grades 2/3). In contrast, all 22 BMS showed complete intimal coverage (grades 2/3). Thrombi were more common in stents with incomplete neointimal coverage (p 0.09). CONCLUSIONS The SES had incomplete neointimal coverage three to six months after implantation, and this was associated with subclinical thrombus formation. (J Am Coll Cardiol 2006;47:2108 –11) ? 2006 by the American College of Cardiology Foundation * Stent thrombosis may occur acutely (within 24 hours of stent placement), subacutely (up to 30 days after stent implantation), as late thrombosis (after 30 days), or as very late thrombosis (after 12 months). The most important risk factors for acute and subacute stent thrombosis are primary stenting in ST-segment elevation myocardial infarction and acute coronary syndromes.20,26 Additio