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目的应用光学相干断层成像(OCT)比较急性心肌梗死(AMI)患者植入不同药物洗脱支架(DES)后的新生内膜覆盖和支架贴壁情况以评估血管愈合。方法 49例AMI患者植入不同DES后9个月时进行OCT检查。其中20个雷帕霉素药物洗脱支架(SES,Cypher),12个紫杉醇药物洗脱支架(PES,Taxus)和17个雷帕霉素衍生物药物洗脱支架(ZES,Endeavor)。每隔1mm评估OCT横断面影像每个支架柱的新生内膜覆盖和贴壁情况,同时观察每个支架内的血栓发生情况。结果总计对12378个支架柱进行了分析。SES的新生内膜增生最少,新生内膜厚度:SES(77±60)μm、PES(153±82)μm、ZES(265±130)μm,且新生内膜增生面积百分比最低,SES(10±8)%、PES(19±8)%、ZES(28±9)%,但SES和PES有更多未被新生内膜覆盖的支架柱,SES(15.1±16)%、PES(7.1±10)%、ZES(0.6±1.5)%,且贴壁不良支架柱的发生率也高于ZES,SES(3.8±7.2)%、PES(2.1±4.4)%、ZES(0±0)%,而有完全新生内膜覆盖的支架比例以ZES为高,SES5%、PES33.3%、ZES82.4%。血栓的发生率SES和PES高于ZES,SES34%、PES33%、ZES6%。结论 AMI患者植入不同类型DES后,其支架的新生内膜覆盖程度和贴壁不良的发生率是显著不同的,因此DES的类型可能影响了AMI血栓性病变的血管愈合过程。
Objective To compare neointimal coverage and stent adherence after implantation of different drug-eluting stents (DES) in patients with acute myocardial infarction (AMI) by optical coherence tomography (OCT) to assess vascular healing. Methods Ninety-nine AMI patients underwent OCT at 9 months after implantation of different DES. Among them, 20 rapamycin-eluting stents (SES, Cypher), 12 paclitaxel-eluting stents (PES, Taxus) and 17 rapamycin-eluting drug-eluting stents (ZES) The neointimal coverage and adherent status of each stent column was evaluated every 1 mm and the occurrence of thrombus in each stent was observed. Results A total of 12378 scaffolds were analyzed. The neointimal hyperplasia of SES was the least, the neointimal thickness was SES (77 ± 60) μm, PES (153 ± 82) μm and ZES (265 ± 130) μm, PES (19 ± 8)% and ZES (28 ± 9)%, respectively. However, there were more scaffolds in SES and PES that were not covered by neointima, SES (15.1 ± 16)%, PES ) And ZES (0.6 ± 1.5)%, respectively. The incidence of poorly adherent stent was also higher than that of ZES, 3.8 ± 7.2% of SES, 2.1 ± 4.4% of PES and 0 ± 0% of ZES, The ratio of scaffolds with complete neointimal coverage was high for ZES, SES5%, PES33.3%, and ZES82.4%. The incidence of thrombosis SES and PES than ZES, SES34%, PES33%, ZES6%. Conclusion The implantation of different types of DES in AMI patients is significantly different in the degree of neointimal coverage and incidence of adherent dysplasia. Therefore, the type of DES may affect the vascular healing process of AMI thrombotic lesions.