血管镜观察药物洗脱支架置入后支架表面内膜覆盖片课件

1、血管镜观察药物洗脱支架置入后支架表面内膜覆盖片血管镜观察药物洗脱支架置入后支架表面内膜覆盖片血管镜观察药物洗脱支架置入后支架表面内膜覆盖片Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapyMcFadden EP, Serryus PW et al. Lancet 2004On 442 days of DES implantation, the patient developed AMI one week after aspirin was discontinu

2、ed because of surgical therapy of colon carcinoma.Pre procedureStent implantationPost procedureLate stent thrombosis2021/4/27血管镜观察药物洗脱支架置入后支架表面内膜覆盖片血管镜观察药物Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapyMcFadden EP, Serryus PW et al. Lancet 2004On 442 day

3、s of DES implantation, the patient developed AMI one week after aspirin was discontinued because of surgical therapy of colon carcinoma.Pre procedureStent implantationPost procedureLate stent thrombosis2021/4/27Late thrombosis in drug-elutinFactors of Stent ThrombosisCoronary blood flowMultiple sten

4、tingProcedure Related FactorsMorphometric abnormalities(Underexpansion, Asymmetry?)Molphologic abnormalities(Dissection, Incomplete appositionThrombus, Tissue protrusion)Mechanical vessel injuryAnti-thrombotic therapyBiocompatibilityPatient / Lesion factorsVessel size, Lesion lengthAcute coronary sy

5、ndromePlaque characteristicsLocal plt / coagulation activityLeft ventricular functionResistance for drugsStent ThrombogenisityMaterialDesignsSurface coatingAdjunctive therapeutic agents(drug, Radiation)Honda Y and Fitzgerald PJ. Circulation 2003;108.Factors of Stent ThrombosisCorAngioscopic Findings

6、 of Neointimal Coverage after Drug Eluting Stent ImplantationCoronary angioscplyVecmova NEO(FiberTech, Tokyo, Japan)Angioscopic Findings of NeoinClassification of Angioscopic FindingsGrade 0Grade 1Grade 2Grade Grade 0: struts were exposed similarly to the time of implantationGrade 1: struts were cov

7、ered, but not embeddedGrade 2: struts were embedded by the neo-intima, but translucency seenGrade 3: struts were fully embedded and invisible by angioscopyKotani J, Awata M, Nanto S, et al. JACC. 2006Classification of Angioscopic Neointimal Coverage Grades 3 to 6 Months After Stent Implantation02550

8、75100Bare-Metal Stent (n=22)(%)1007550250Incomplete coverage Sirolimus-Eluting Stent (n=15)Complete coverageGrade 3Grade 2Grade 1Grade 0Kotani J, Awata M, Nanto S, et al. JACC. 2006Neointimal Coverage Grades 3 Representative Cases: BMS vs. SESBare-metal stent (BMS) Sirolimus-eluting stent (SES) (Gra

9、de 3) (Grade 1)Stent: Cypher 3.518mmLocation: RCA mid3.7 months f-upStent: Bx Velocity 3.523mmLocation: LAD mid2.7 months f-upRepresentative Cases: BMS vs. A Case implanted both BMS and DESFollow up 3.7 monthsBx Verocity 3.01859 y.o. female Cypher 3.518A Case implanted both BMS and 12 months24 month

10、s monthsChanges in Neointimal Coverage GradeAwata M, Kotani J, Nanto S et al. Circulation. 200712 months24 months monthsChanComparison of Angioscopic FindingsSES versus PES at 8 MonthsThirty PES were angioscopically compared with 36 SES.Intra- and inter-stent heterogeneinty of neointimal coverage we

11、re more common in PES.Incidence of thrombi and yellow plaques were similar between the two groups.Awata M, Nanto S et al. JACC Cardiol Intv 2009Comparison of Angioscopic FindNeointimal Coverage Grades at 8 monthsPES (n=30)SES (n=36)Grade 0Grade 1Grade 2Grade 3PES vs. SES: p=0.002 by 2 test test(%)Aw

12、ata M, Nanto S et al. JACC Cardiol Intv 2009Neointimal Coverage Grades at HomogeneousHeterogeneity of Neointimal Coverage GradesAwata M, Nanto S et al. JACC Cardiol Intv 2009PES vs. SES: p=0.0006 by 2 testHeterogeneityof 1 gradePES(n=30)SES(n=36)Heterogeneous53%47%26%48%26%HomogeneityHeterogeneityof

13、 2 grade74%HomogeneousHeterogeneity of NeComparison of Angioscopic FindingsSES versus ZES at 8 MonthsAwata M, Nanto S, et al. JACC. 2008Cypher 3.523mmEndeavor 3.523mmComparison of Angioscopic FindNeointimal Coverage Grades at 8 months(%)Awata M, Nanto S, et al. JACC. 2008In-stent ate loss - SES = 0.

14、07 0.18mm - ZES = 0.51 0.17mm （p0.0001）Neointimal Coverage Grades atIncidence of Thrombi and Yellow plaques(n=14)(n=16)P=0.2(n=14)(n=16)P=0.004ThrombiYellow plaquesIncidence of Thrombi and YelloAngioscopic Findings ZES vs. SES8 mo. after implantation11 mo. after implantationAngioscopic Findings ZES

15、Results of ENDEAVOR-IIIPatient Frequency Distributions of In-segment Late Loss0.130.32 0.340.44 2021/4/27Results of ENDEAVOR-IIIPatientResults of ENDEAVOR-IIIPatient Frequency Distributions of In-segment Late Loss0.130.32 0.340.44 2021/4/27Results of ENDEAVOR-IIIPatientThe Ideal DES Should Have Opti

16、mal Late Loss with Narrow Distributions0.130.32 0.340.44 Ideal DES2021/4/27The Ideal DES Should Have OptSummaryAngiographic findings of DES revealedProlonged delayed growth of neointimaPoor but homogenous covering over SESHeterogeneous luminal surface of PESWhite and homogenous appearance in patients treated with ZES:Basically grade 3 neoinitmaA few yellow plaques and thrombi SummaryAngiographic findings oTake Home MassagesNew Concept for Next-generation DESConsidering the risk of stent thrombosis due to incomp