血管镜观察药物洗脱支架置入后支架表面内膜覆盖幻灯片教学课件.pptVIP

Drug-eluting stents have remarkably reduced restenosis rate through inhibiting neointimal hyperplasia. However, the relationship between DES and late stent thrombosis has been of interest since the cases with very late stent thrombosis were reported in Lancet. * There are many factors related stent thrombosis, i.e. stent thromobogenisity, patient and/or lesion factors, and procedure factors. I have speculated that delayed healing of neoitima after drug eluting stent implantation might be one of the causes of stent thrombosis. * Thus, we have investigated the vascular surface after placement of a drug eluting stent using coronary angioscopy. All angioscopic evaluation was conducted using Vecmova?. * We classified the degree of neointimal coverage over the stent into 4 grades as shown in this slide. When struts were exposed similarly to the time of implantation, it was defined as grade 0 Struts were covered, but not embedded,,,,,,as grdade 1. Struts were embedded by the neo-intima, but translucency seen,,,,, as Grade 2. Struts were fully embedded and invisible by angioscopy,,,,,, as Grade 3. * This slide shows the neointimal coverage grades 3 to 6 months after SES and BMS implanted for de novo lesions. When you see BMS, about 80% of BMS showed grade 3 coverage. In contrast, more than 70% of SES had grade 1 coverage. As shown in this slide, neointimal growth was strongly suppressed with SES when compared to BMS. * Movies of the representative cases are presented here. The left side movie shows internal surface of the BMS 2.7 months after implantation, and the right side reveals that of the SES 3.7 months after implantation. As you can easy recognize, the BMS struts were fully embedded by the neointima and invisible as demonstrated in the left panel. In contrast, as shown in the right panel, the SES was not embedded by the neointima. * This case was implated both BMS and SES in hybrid manner. Bx velocity implanted disatal LAD and Cyhper proximally. Agiogr