血管镜观察药物洗脱支架置入后支架表面内膜覆盖课件_1

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1、AngioscopicFindingsofNeointimalCoverageafterDrugElutingStentImplantationShinsukeNanto,M.D.,PhD.DepartmentofAdvancedCardiovascularTherapeuticsOsakaUniversityGraduateSchoolofMedicineLatethrombosisindrug-elutingcoronarystentsafterdiscontinuationofantiplateletthe

2、rapyMcFaddenEP,SerryusPWetal.Lancet2004On442daysofDESimplantation,thepatientdevelopedAMIoneweekafteraspirinwasdiscontinuedbecauseofsurgicaltherapyofcoloncarcinoma.PreprocedureStentimplantationPostprocedureLatestentthrombosisFactorsofStentThrombosisCoronarybloo

3、dflowMultiplestentingProcedureRelatedFactorsMorphometricabnormalities(Underexpansion,Asymmetry?)Molphologicabnormalities(Dissection,IncompleteappositionThrombus,Tissueprotrusion)MechanicalvesselinjuryAnti-thrombotictherapyBiocompatibilityPatient/LesionfactorsV

4、esselsize,LesionlengthAcutecoronarysyndromePlaquecharacteristicsLocalplt/coagulationactivityLeftventricularfunctionResistancefordrugsStentThrombogenisityMaterialDesignsSurfacecoatingAdjunctivetherapeuticagents(drug,Radiation)HondaYandFitzgeraldPJ.Circulation20

5、03;108.AngioscopicFindingsofNeointimalCoverageafterDrugElutingStentImplantationCoronaryangioscplyVecmovaNEO™(FiberTech,Tokyo,Japan)ClassificationofAngioscopicFindingsGrade0Grade1Grade2Grade３Grade0:strutswereexposedsimilarlytothetimeofimplantationGrade1:strut

6、swerecovered,butnotembeddedGrade2:strutswereembeddedbytheneo-intima,buttranslucencyseenGrade3:strutswerefullyembeddedandinvisiblebyangioscopyKotaniJ,AwataM,NantoS,etal.JACC.2006NeointimalCoverageGrades3to6MonthsAfterStentImplantation0255075100Bare-MetalStent(n

7、=22)(%)1007550250IncompletecoverageSirolimus-ElutingStent(n=15)CompletecoverageGrade3Grade2Grade1Grade0KotaniJ,AwataM,NantoS,etal.JACC.2006RepresentativeCases:BMSvs.SESBare-metalstent(BMS)Sirolimus-elutingstent(SES)(Grade3)(Grade1)Stent:Cypher3.5×18mmLocation:

8、RCAmid3.7monthsf-upStent:BxVelocity3.5×23mmLocation:LADmid2.7monthsf-upACaseimplantedbothBMSandDESFollowup3.7monthsBxVerocity3.01859y.o.femaleCypher3.51812months24months４monthsCh