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.ppt

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 discontinued because of surgical therapy of colon ca

2、rcinoma.Pre procedureStent implantationPost procedureLate stent thrombosis2021/4/27L a t e t h r o mb o s i s i n d r u g-e l u t i nFactors of Stent ThrombosisCoronary blood flowMultiple stentingProcedure Related FactorsMorphometric abnormalities(Underexpansion,Asymmetry?)Molphologic abnormalities(

3、Dissection,Incomplete appositionThrombus,Tissue protrusion)Mechanical vessel injuryAnti-thrombotic therapyBiocompatibilityPatient/Lesion factorsVessel size,Lesion lengthAcute coronary syndromePlaque characteristicsLocal plt/coagulation activityLeft ventricular functionResistance for drugsStent Throm

4、bogenisityMaterialDesignsSurface coatingAdjunctive therapeutic agents(drug,Radiation)Honda Y and Fitzgerald PJ.Circulation 2003;108.F a c t o r s o f S t e n t T h r o mb o s i s C o rAngioscopic Findings of Neointimal Coverage after Drug Eluting Stent ImplantationCoronary angioscplyVecmova NEO(Fibe

5、rTech,Tokyo,Japan)A n g i o s c o p i c F i n d i n g s o f N e o i nQuickTime遣DV/DVCPRO-NTSC 闘恚蓈社蒓赦赡菣潜敲蓅蒒蒨缮蔷濠侨菫墙菂钦颣髒黔菑臖C l a s s i f i c a t i o n o f A n g i o s c o p i c Neointimal Coverage Grades 3 to 6 Months After Stent Implantation0255075100Bare-Metal Stent(n=22)(%)1007550250Incomplete cover

6、age Sirolimus-Eluting Stent(n=15)Complete coverageN e o i n t i ma l C o v e r a g e G r a d e s 3 Bare-metal stent(BMS)Sirolimus-eluting stent(SES)R e p r e s e n t a t i v e C a s e s:B MS v s.Follow up 3.7 months59 y.o.female A C a s e i mp l a n t e d b o t h B MS a n d Bare-metal stentFirst fol

7、low-upSecond follow-upThird follow-upNeointimal coverage grade0123Sirolimus-eluting stentn=1n=1n=13n=13n=10n=10n=11n=4n=4n=3n=412 months24 monthsBare-metal stentFirst follow-upSecond follow-upThird follow-upNeointimal coverage grade0123Sirolimus-eluting stentn=1n=1n=13n=13n=10n=10n=11n=4n=4n=3n=4 mo

8、nthsChanges in Neointimal Coverage Grade1 2 mo n t h s 2 4 mo n t h s mo n t h s C h a nComparison of Angioscopic FindingsSES versus PES at 8 MonthsThirty PES were angioscopically compared with 36 SES.Intra-and inter-stent heterogeneinty of neointimal coverage were more common in PES.Incidence of th

9、rombi and yellow plaques were similar between the two groups.C o mp a r i s o n o f A n g i o s c o p i c F i n dNeointimal Coverage Grades at 8 monthsN e o i n t i ma l C o v e r a g e G r a d e s a t HomogeneousHeterogeneity of Neointimal Coverage GradesPES vs.SES:p=0.0006 by 2 testHeterogeneityof

10、 1 gradePES(n=30)SES(n=36)Heterogeneous53%47%26%48%26%HomogeneityHeterogeneityof 2 grade74%H o mo g e n e o u s H e t e r o g e n e i t y o f N eComparison of Angioscopic FindingsSES versus ZES at 8 MonthsCypher 3.523mmEndeavor 3.523mmC o mp a r i s o n o f A n g i o s c o p i c F i n dNeointimal Co

11、verage Grades at 8 months(%)N e o i n t i ma l C o v e r a g e G r a d e s a tIncidence of Thrombi and Yellow plaquesP=0.2P=0.004ThrombiYellow plaquesI n c i d e n c e o f T h r o mb i a n d Y e l l oAngioscopic Findings ZES vs.SES8 mo.after implantationA n g i o s c o p i c F i n d i n g s Z E S Pa

12、tient Frequency Distributions of In-segment Late Loss2021/4/27R e s u l t s o f E N D E A V O R-I I I P a t i e n tPatient Frequency Distributions of In-segment Late Loss2021/4/27R e s u l t s o f E N D E A V O R-I I I P a t i e n t2021/4/27T h e I d e a l D E S S h o u l d H a v e O p tSummaryAngio

13、graphic 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 neoinitmaA few yellow plaques and thrombi S u mma r y A n g i o g r a p h i

14、 c f i n d i n g s oTake Home MassagesNew Concept for Next-generation DESConsidering the risk of stent thrombosis due to incomplete neointimal coverage,it is preferable for DES to have sufficient neointimal volume with homogeneous coverage.Optimal late loss with homogeneous coverage may be desirable for adequate endothelial healing following stenting.T a k e H o me Ma s s a g e sN e w C o n c e p t谢谢！谢谢！