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首页> 外文期刊>Osaka City Medical Journal >The Impact of IVUS Guided Bare Metal Stent Implantation for Non-Small Vessel
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The Impact of IVUS Guided Bare Metal Stent Implantation for Non-Small Vessel

机译：IVUS引导裸金属支架植入对非小血管的影响

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摘要

Previous studies have shown larger target vessel or greater stent area contribute to reduced restenosis rate. Thus, intravascular ultrasound (IVUS)-guided bare metal stent (BMS) implantation for selected lesions might achieve drug-eluting stent-like outcomes. The aim was to examine the long-term outcomes of BMS using IVUS-guided optimization. Methods Consecutive 103 coronary artery lesions suitable for IVUS were enrolled. Using IVUS, final stent balloon size selected was 90 percent of media-to-media diameter at the lesion or distal reference. The balloon size was listed as follows: group A (3.0-3.5 mm, n=15), group B (3.5-3.75 mm, n=64), and group C (3.75-4.5 mm, n=24). Results At post-intervention, average stent area increased by the balloon size (A: 7.2 ± 1.4 mm~2, B: 8.9±1.5 mm~2, and C: 12.1±2.0 mm~2, respectively p < 0.001). At 6 month follow up, the average lumen area increased by balloon size (A: 4.1±1.7 mm~2, B: 5.7±1.2 mm~2, and C: 8.1±2.0 mm~2, respectively p < 0.001). Accordingly, group B and C revealed lower restenosis, compared to group A (A: 46.7%. B: 10.9%, C: 8.3%, A vs B: p=0.001; C vs A: p=0.015). Moreover, target lesion revascularization was less in group B and C than group A (A 26.6%, B 3.1%, C 0%, A vs B: p=0.011; C vs A: p=0.017). Conclusions For non-small vessels, IVUS-guided BMS implantation showed less restenosis and target lesion revascularization compared to small vessels, mainly due to larger initial gain. These study results suggest that IVUS-guided optimal BMS implantation for selected lesions might result in favorable long-term outcomes similar to those seen using drug-eluting stents. For a decade, coronary stenting has become a standard therapy for coronary artery disease due to favorable long-term outcomes and simple treatment procedure. Furthermore, for the last two years, drug-eluting stents (DES), releasing antiproliferative agents from bare metal backbone, revealed the restenosis rates less than half of those seen using conventional bare metal stents (BMS). While target lesions especially suitable for DES continue to be identified, earlier BMS studies showed that larger target vessel or greater stent area contributed to less restenosis. Thus, optimal IVUS-guided BMS implantation for selected lesions might achieve DES-like long-term outcomes. This study was designed to examine the long-term outcomes of BMS with intravascular ultrasound (IVUS)-guided optimization, using coronary angiography and IVUS data.
机译：先前的研究表明，更大的目标血管或更大的支架面积有助于降低再狭窄率。因此，针对特定病变的血管内超声（IVUS）引导的裸金属支架（BMS）植入可能会实现药物洗脱的支架样结果。目的是使用IVUS指导的优化方法检查BMS的长期结果。方法选择适合IVUS的103例连续冠状动脉病变。使用IVUS，最终选择的支架球囊尺寸为病变或远端参考处的介质间直径的90％。气囊尺寸如下：A组（3.0-3.5mm，n ＝ 15），B组（3.5-3.75mm，n ＝ 64）和C组（3.75-4.5mm，n ＝ 24）。结果干预后，平均支架面积随球囊尺寸的增加而增加（A：7.2±1.4 mm〜2，B：8.9±1.5 mm〜2，C：12.1±2.0 mm〜2，p <0.001）。随访6个月时，平均管腔面积随球囊尺寸的增加而增加（A：4.1±1.7 mm〜2，B：5.7±1.2 mm〜2，C：8.1±2.0 mm〜2，p <0.001）。因此，与A组相比，B和C组显示出较低的再狭窄（A：46.7％。B：10.9％，C：8.3％，A对B：p = 0.001； C对A：p = 0.015）。此外，B组和C组的目标病变血运重建率均低于A组（A 26.6％，B 3.1％，C 0％，A对B：p = 0.011； C对A：p = 0.017）。结论对于非小血管，与小血管相比，IVUS引导的BMS植入显示出较少的再狭窄和靶病变血运重建，这主要是由于初始增益更大。这些研究结果表明，IVUS引导的针对特定病变的最佳BMS植入可能会产生有利的长期结果，类似于使用药物洗脱支架所见的结果。十年来，由于良好的长期效果和简单的治疗程序，冠状动脉支架置入术已成为冠状动脉疾病的标准疗法。此外，在最近两年中，药物洗脱支架（DES）从裸金属骨架释放抗增殖剂，显示出再狭窄率不到使用常规裸金属支架（BMS）的一半。尽管仍能确定出特别适合DES的靶病变，但早期的BMS研究表明，更大的靶血管或更大的支架面积有助于减少再狭窄。因此，针对特定病变的最佳IVUS引导BMS植入可能会获得类似DES的长期结果。这项研究旨在通过冠状动脉造影和IVUS数据，以血管内超声（IVUS）指导的优化检查BMS的长期结果。

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