1、Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent ImplantationShinsuke Nanto,M.D.,PhD.Department of Advanced Cardiovascular TherapeuticsOsaka University Graduate School of MedicineA n g i o s c o p i c F i n d i n g s o f N e o i n tLate thrombosis in drug-eluting coronary stents
2、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 carcinoma.Pre procedureStent implantationPost procedureLate stent thrombosisL a
3、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(Dissection,Incomplete appositionThrombus,Tissue protrusion)Mechanical vessel injuryAnti
4、-thrombotic therapyBiocompatibilityPatient/Lesion factorsVessel size,Lesion lengthAcute coronary syndromePlaque characteristicsLocal plt/coagulation activityLeft ventricular functionResistance for drugsStent ThrombogenisityMaterialDesignsSurface coatingAdjunctive therapeutic agents(drug,Radiation)Ho
5、nda 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(FiberTech,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/DVCPR
6、O-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 coverage Sirolimus-Eluting Stent(n=15)Complete coverageN e o i n t i ma l C o v e r a g e G
7、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 follow-upSecond follow-upThird follow-upNeointimal coverage grade0123Sirolimus-eluting ste
8、ntn=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 monthsChanges 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
9、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 thrombi and yellow plaques were similar between the two groups.C o mp a r i s o n o f A n
10、 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 1 gradePES(n=30)SES(n=36)Heterogeneous53%47%26%48%26%HomogeneityHeterogeneityof 2 grad
11、e74%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 Coverage 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
12、 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 Patient Frequency Distributions of In-segment Late LossR e s u l t s o f E N D E A V O R-
13、I I I P a t i e n tPatient Frequency Distributions of In-segment Late LossR 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 tT h e I d e a l D E S S h o u l d H a v e O p tSummaryAngiographic findings of DES revealed Prolonged delayed growth of neointima Poor but homogenous covering over SES Heter
14、ogeneous 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 c f i n d i n g s o提问与解答环节Questions And Answers提问与解答环节谢谢聆听 学习就是为了达到一定目的而努力去干,是为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和挫折Learning Is To Achieve A Certain Goal And Work Hard,Is A Process To Overcome Various Difficulties For A Goal谢谢聆听L e a r n i n g I s T o A c h i e v e A C
