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目的应用冠脉内超声测量支架置入6个月后内膜增生厚度,准确比较不同支架再狭窄率。方法选择57例药物洗脱支架(DES)置入术后4～8(6±2)个月同意复查冠脉造影及冠脉血管内超声的冠心病(CHD)住院患者,分为Cypher支架组(25例)和Firebird支架组(32例),及同期491例植入金属裸支架(BMS)CHD患者,测量支架置入后6个月时的内膜增生并进行比较。结果冠脉造影显示DES发生再狭窄Cypher组11例,Firebird组10例,裸支架组25例。再狭窄率分别为8.4%,8.9%和10.0%。DES两组差异无统计学意义,裸支架组与Cypher组及Firebird组相比较差异有显著性。冠脉内超声检查结果显示DES组中Cypher支架新生内膜面积为(1.11±0.89)mm2,支架再狭窄率(9.0±0.1)%;Firebird组为(1.13±0.08)mm2,支架再狭窄率(10.0±0.2)%。DES两组间比较差异无统计学意义。裸支架组支架新生内膜面积为(1.44±0.04)mm2,再狭窄率为(21.0±0.1)%,与DES两组比较,有显著的统计学差异(P<0.05)。支架两端的节段狭窄率DES组中近端的节段狭窄Cypher组(0.43±0.25)%与Firebird组(0.40±0.15)%都显著高于裸金属支架组(0.29±0.13)%(P<0.05)。远端的节段狭窄率,三组比较差异无统计学意义。结论应用冠脉内超声评价支架内再狭窄准确度优于冠脉造影。DES降低支架内再狭窄率明显优于裸金属支架,防止支架节段狭窄,裸金属支架可能有优势。
Objective To evaluate the thickness of neointimal hyperplasia after coronary stent implantation for 6 months by using intracoronary ultrasound and to compare accurately the restenosis rates of different stents. Methods Fifty-seven DES patients were enrolled into hospital for coronary heart disease (CHD) who agreed to repeat coronary angiography and intracoronary ultrasound 4 to 8 (6 ± 2) months after PCI. The patients were divided into Cypher stent group (25 cases), Firebird stent group (32 cases) and 491 CHD patients with bare metal stent (BMS) during the same period. Intimal hyperplasia was measured at 6 months after stent implantation and compared. Results Coronary angiography showed that there were 11 cases of restenosis in DES group, 10 cases in Firebird group and 25 cases in bare stent group. Restenosis rates were 8.4%, 8.9% and 10.0%, respectively. There was no significant difference in DES between the two groups. There was significant difference between naked stent group and Cypher group and Firebird group. Coronary ultrasound findings showed that the neointimal area of the Cypher stent was (1.11 ± 0.89) mm2 and the stent restenosis rate was (9.0 ± 0.1)% in the DES group and (1.13 ± 0.08) mm2 in the Firebird group. The stent restenosis rate 10.0 ± 0.2)%. DES no significant difference between the two groups. The neointimal area of the stent group was (1.44 ± 0.04) mm2 and the restenosis rate was (21.0 ± 0.1)%. There was a significant difference between the two groups (P <0.05). The stenosis at both ends of the stent group was significantly higher in the Cypher group (0.43 ± 0.25)% vs Firebird group (0.40 ± 0.15)% than in the bare metal stent group (0.29 ± 0.13)% (P < 0.05). The distal stenosis rate, no significant difference between the three groups. Conclusion The application of intracoronary ultrasound to evaluate the accuracy of stent restenosis is superior to coronary angiography. DES reduces the rate of stent restenosis was significantly better than the bare metal stent to prevent the stent segment stenosis, bare metal stent may have advantages.