最新血管镜观察药物洗脱支架置入后支架表面内膜覆盖幻灯片教学讲义PPT.ppt

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1、血管镜观察药物洗脱支架置入后支架表面内膜覆盖幻灯片Latethrombosisindrug-elutingcoronarystentsafterdiscontinuationofantiplatelettherapyMcFaddenEP,SerryusPWetal.Lancet2004On442daysofDESimplantation,thepatientdevelopedAMIoneweekafteraspirinwasdiscontinuedbecauseofsurgicaltherapyo

2、fcoloncarcinoma.PreprocedureStentimplantationPostprocedureLatestentthrombosisFactorsofStentThrombosisCoronarybloodflowMultiplestentingProcedureRelatedFactorsMorphometricabnormalities(Underexpansion,Asymmetry?)Molphologicabnormalities(Dissection,Incomp

3、leteappositionThrombus,Tissueprotrusion)MechanicalvesselinjuryAnti-thrombotictherapyBiocompatibilityPatient/LesionfactorsVesselsize,LesionlengthAcutecoronarysyndromePlaquecharacteristicsLocalplt/coagulationactivityLeftventricularfunctionResistanceford

4、rugsStentThrombogenisityMaterialDesignsSurfacecoatingAdjunctivetherapeuticagents(drug,Radiation)HondaYandFitzgeraldPJ.Circulation2003;108.RepresentativeCases:BMSvs.SESBare-metalstent(BMS)Sirolimus-elutingstent(SES)(Grade3)(Grade1)Stent:Cypher3.5×18mmL

5、ocation:RCAmid3.7monthsf-upStent:BxVelocity3.5×23mmLocation:LADmid2.7monthsf-upACaseimplantedbothBMSandDESFollowup3.7monthsBxVerocity3.01859y.o.femaleCypher3.51812months24months４monthsChangesinNeointimalCoverageGradeAwataM,KotaniJ,NantoSetal.Circula

6、tion.2007ComparisonofAngioscopicFindingsSESversusPESat8MonthsThirtyPESwereangioscopicallycomparedwith36SES.Intra-andinter-stentheterogeneintyofneointimalcoverageweremorecommoninPES.Incidenceofthrombiandyellowplaquesweresimilarbetweenthetwogroups.Awat

7、aM,NantoSetal.JACCCardiolIntv2009NeointimalCoverageGradesat8monthsPES(n=30)SES(n=36)Grade0Grade1Grade2Grade3PESvs.SES:p=0.002byχ2testtest(%)AwataM,NantoSetal.JACCCardiolIntv2009HomogeneousHeterogeneityofNeointimalCoverageGradesAwataM,NantoSetal.JACCCa

8、rdiolIntv2009PESvs.SES:p=0.0006byχ2testHeterogeneityof1gradePES(n=30)SES(n=36)Heterogeneous53%47%26%48%26%HomogeneityHeterogeneityof2grade74%ComparisonofAngioscopicFindingsSESversusZESat8MonthsAwataM,NantoS,etal.JACC.2008Cypher3.5×23mmEndeavo