血管镜观察药物洗脱支架置入后支架表面内膜覆盖.ppt

1、Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent Implantation,Shinsuke Nanto, M.D., PhD.,Department of Advanced Cardiovascular Therapeutics Osaka University Graduate School of Medicine,Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy,M

2、cFadden EP, Serryus PW et al. Lancet 2004,On 442 days of DES implantation, the patient developed AMI one week after aspirin was discontinued because of surgical therapy of colon carcinoma.,Pre procedure,Stent implantation,Post procedure,Late stent thrombosis,Factors of Stent Thrombosis,Honda Y and F

3、itzgerald PJ. Circulation 2003;108.,Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent Implantation,Coronary angioscply Vecmova NEO (FiberTech, Tokyo, Japan),Classification of Angioscopic Findings,Grade 0,Grade 1,Grade 2,Grade ,Grade 0: struts were exposed similarly to the time of

4、implantation Grade 1: struts were covered, but not embedded Grade 2: struts were embedded by the neo-intima, but translucency seen Grade 3: struts were fully embedded and invisible by angioscopy,Kotani J, Awata M, Nanto S, et al. JACC. 2006,Neointimal Coverage Grades 3 to 6 Months After Stent Implan

5、tation,Bare-Metal Stent (n=22),(%),Incomplete coverage,Sirolimus-Eluting Stent (n=15),Complete coverage,Grade 3,Grade 2,Grade 1,Grade 0,Kotani J, Awata M, Nanto S, et al. JACC. 2006,Representative Cases: BMS vs. SES,Bare-metal stent (BMS) Sirolimus-eluting stent (SES) (Grade 3) (Grade 1),Stent: Cyph

6、er 3.518mm Location: RCA mid 3.7 months f-up,Stent: Bx Velocity 3.523mm Location: LAD mid 2.7 months f-up,A Case implanted both BMS and DES,Follow up 3.7 months,Bx Verocity 3.018,59 y.o. female,Cypher 3.518,12 months,24 months, months,Changes in Neointimal Coverage Grade,Awata M, Kotani J, Nanto S e

7、t al. Circulation. 2007,Comparison of Angioscopic FindingsSES versus PES at 8 Months,Thirty PES were angioscopically compared with 36 SES. Intra- and inter-stent heterogeneinty of neointimal coverage were more common in PES. Incidence of thrombi and yellow plaques were similar between the two groups

8、.,Awata M, Nanto S et al. JACC Cardiol Intv 2009,Neointimal Coverage Grades at 8 months,Grade 0,Grade 1,Grade 2,Grade 3,PES vs. SES: p=0.002 by 2 test test,(%),Awata M, Nanto S et al. JACC Cardiol Intv 2009,Homogeneous,Heterogeneity of Neointimal Coverage Grades,Awata M, Nanto S et al. JACC Cardiol

9、Intv 2009,PES vs. SES: p=0.0006 by 2 test,Heterogeneity of 1 grade,PES (n=30),SES (n=36),Heterogeneous,53%,47%,26%,48%,26%,Homogeneity,Heterogeneity of 2 grade,74%,Comparison of Angioscopic FindingsSES versus ZES at 8 Months,Awata M, Nanto S, et al. JACC. 2008,Cypher 3.523mm,Endeavor 3.523mm,Neointi

10、mal Coverage Grades at 8 months,In-stent ate loss - SES = 0.07 0.18mm - ZES = 0.51 0.17mm （p0.0001）,Incidence of Thrombi and Yellow plaques,(n=14),(n=16),P=0.2,(n=14),(n=16),P=0.004,Thrombi,Yellow plaques,Angioscopic Findings ZES vs. SES,8 mo. after implantation,11 mo. after implantation,Results of

11、ENDEAVOR-III,Patient Frequency Distributions of In-segment Late Loss,0.130.32,0.340.44,Results of ENDEAVOR-III,Patient Frequency Distributions of In-segment Late Loss,0.130.32,0.340.44,The Ideal DES Should Have Optimal Late Loss with Narrow Distributions,0.130.32,0.340.44,Ideal DES,Summary,Angiograp

12、hic findings of DES revealed Prolonged delayed growth of neointima Poor but homogenous covering over SES Heterogeneous luminal surface of PES White and homogenous appearance in patients treated with ZES: Basically grade 3 neoinitma A few yellow plaques and thrombi,Take Home MassagesNew Concept for Next-generation DES,Considering the risk of stent thrombosis due to incomplete neointimal coverage, it is pr