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ȣ - 510053 304 |
Vascular responses at proximal and distal edges of drug-eluting stents: serial intravascular ultrasound analysis from prospective, multicenter, randomized trial |
국민건강보험공단 일산병원¹ ,가천의대 부속 길병원² ,연세대학교 신촌세브란스병원³ |
오성진¹, 김병극¹ ,전동운¹ ,안태훈² ,장양수³ ,양주영¹ |
Objective We used serial intravascular ultrasound(IVUS) to analyze stent edges of drug-eluting stents(DES). Method We used the POET trial data which is a prospective, multicenter, randomized trial for evaluating the efficacy of adjuvant balloons in procedure using DESs randomly allocated (SES vs. PES). Serial(baseline and 8month follow-up) IVUS analysis was performed at 5mm reference segments proximal and distal to the DES. Results A total 301 patients with denovo lesion were treated and baseline characteristics showed no significant differences between groups. At the proximal edge, SES showed significant constrictive vascular remodeling(65.10±20.08mm2 to 61.65±18.71mm2, p=0.041), whereas PES showed significant plaque progression(22.77±12.34mm2 to 26.81±11.68mm2, p=0.006). All these resulted in significant lumen area decrease in both group(40.27±10.23mm2 to 36.51±10.17mm2 in SES & 37.57±11.10mm2 to 31.74±10.57mm2 in PES, p<0.05 in both/ p=ns when comparing SES & PES). At the distal edge, only SES showed significant change in plaque area(12.58±9.20mm2 to 14.33±10.06mm2, p=0.02), which did not resulted in lumen area decrease(29.90±10.29mm2 to 28.70±9.19mm2, p=ns) because of mild positive vascular remodeling(42.39±18.16mm2 to 43.03±17.82mm2). There were no significant area changes in PES. Conclusion After stenting using DES, IVUS revealed significant luminal dicrease only at proximal edge caused by some negative remodeling(more pronounced in SES) and plaque progression(more pronounced in PES).
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Proximal edge |
SES (n=61) |
PES (n=78) |
CSA(mm2) |
Vessel |
Plaque |
Lumen |
Vessel |
Plaque |
Lumen |
Post
PCI |
65.10±20.08 |
24.82±12.57 |
40.27±10.23 |
60.34±19.20 |
22.77±12.34 |
37.57±11.10 |
Follow
up |
61.65±18.71 |
25.14±10.46 |
36.51±10.17 |
58.55±19.70 |
26.81±11.68 |
31.74±10.57 |
p |
0.041 |
ns |
0.024 |
ns |
0.006 |
0.006 |
Distal
edge |
SES (n=82) |
PES (n=99) |
Post
PCI |
42.49±18.16 |
12.58±9.20 |
29.90±10.29 |
42.35±16.78 |
14.77±11.01 |
27.58±7.81 |
Follow
up |
43.03±17.82 |
14.33±10.06 |
28.70±9.19 |
40.63±16.67 |
15.29±12.26 |
25.34±6.92 |
p |
ns |
0.020 |
ns |
ns |
ns |
ns |
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