Abstract：
OBJECTIVE: This pilot study assessed the 12-month angiographic and clinical outcomes of self-apposing (SA) stents in patients undergoing chronic total occlusion (CTO) percutaneous coronary intervention (PCI).
BACKGROUND: Self-apposing (SA) stents may decrease incomplete strut apposition and stent strut coverage that are common after CTO PCI.
METHODS: We compared 20 patients who underwent CTO PCI using SA drug-eluting stents (DESs) with 20 matched control patients who underwent CTO PCI using balloon-expandable (BE)-DESs. All patients were followed up clinically for 12 months and had coronary angiography with optical coherence tomography at the end of the follow-up period. The primary end points were stent strut malapposition and strut coverage. The secondary end point was composite major adverse cardiovascular events (MACEs) at 12 months.
RESULTS: Both groups had high prevalence of diabetes mellitus, and most of the treated lesions were complex, with 62% having a J-CTO score of ≥3. All CTO PCI techniques were allowed for recanalisation, and 75% of the procedures were guided by intravascular ultrasound. At 12 months, the SA-DES group had fewer malapposed struts (0% [interquartile range (IQR) 0%-0%] vs 4.5% [IQR 0%-20%]; p<0.001) and uncovered struts (0.08% [IQR 0%-1.6%] vs 8.2% [IQR 0%-16%]; p<0.001). However, they showed significantly higher rates of MACEs due to clinically-driven target lesion revascularisation (45% vs 15%; p=0.038).
CONCLUSIONS: In this pilot study, compared with conventional BE-DESs, SA-DESs used in CTO PCI were associated with fewer malapposed and uncovered stent struts but also with significantly higher rates of in-stent restenosis and MACEs, mainly caused by clinically driven target lesion revascularisation.
BACKGROUND: Self-apposing (SA) stents may decrease incomplete strut apposition and stent strut coverage that are common after CTO PCI.
METHODS: We compared 20 patients who underwent CTO PCI using SA drug-eluting stents (DESs) with 20 matched control patients who underwent CTO PCI using balloon-expandable (BE)-DESs. All patients were followed up clinically for 12 months and had coronary angiography with optical coherence tomography at the end of the follow-up period. The primary end points were stent strut malapposition and strut coverage. The secondary end point was composite major adverse cardiovascular events (MACEs) at 12 months.
RESULTS: Both groups had high prevalence of diabetes mellitus, and most of the treated lesions were complex, with 62% having a J-CTO score of ≥3. All CTO PCI techniques were allowed for recanalisation, and 75% of the procedures were guided by intravascular ultrasound. At 12 months, the SA-DES group had fewer malapposed struts (0% [interquartile range (IQR) 0%-0%] vs 4.5% [IQR 0%-20%]; p<0.001) and uncovered struts (0.08% [IQR 0%-1.6%] vs 8.2% [IQR 0%-16%]; p<0.001). However, they showed significantly higher rates of MACEs due to clinically-driven target lesion revascularisation (45% vs 15%; p=0.038).
CONCLUSIONS: In this pilot study, compared with conventional BE-DESs, SA-DESs used in CTO PCI were associated with fewer malapposed and uncovered stent struts but also with significantly higher rates of in-stent restenosis and MACEs, mainly caused by clinically driven target lesion revascularisation.
摘要：
目的：这项初步研究评估了接受慢性完全闭塞（CTO）经皮冠状动脉介入治疗（PCI）的患者使用自立（SA）支架的12个月血管造影和临床结果。
背景：自贴壁（SA）支架可能会降低CTOPCI后常见的不完全支柱贴壁和支架支柱覆盖率。
方法：我们比较了20例使用SA药物洗脱支架（DESs）进行CTOPCI的患者与20例使用球囊扩张（BE）-DESs进行CTOPCI的对照组患者。所有患者均临床随访12个月，随访期末行冠状动脉造影光学相干断层扫描。主要终点是支架支柱贴壁不良和支柱覆盖。次要终点是12个月时的复合主要不良心血管事件（MACEs）。
结果：两组的糖尿病患病率都很高，大多数治疗的病变都很复杂，62%的患者J-CTO评分≥3分。所有CTOPCI技术都允许进行再通，75%的手术由血管内超声引导。12个月时,SA-DES组贴壁不良支柱较少(0%[四分位距(IQR)0%-0%]vs4.5%[IQR0%-20%];p<0.001),未覆盖支柱(0.08%[IQR0%-1.6%]vs8.2%[IQR0%-16%];p<0.001).然而,他们显示,由于临床驱动的靶病变血运重建,MACE的发生率显著较高(45%vs15%;p=0.038).
结论：在这项初步研究中，与传统的BE-DES相比，CTOPCI中使用的SA-DES与较少的贴壁不良和未覆盖的支架支柱相关，但支架内再狭窄和MACE发生率明显较高。主要由临床驱动的靶病变血运重建引起。
背景：自贴壁（SA）支架可能会降低CTOPCI后常见的不完全支柱贴壁和支架支柱覆盖率。
方法：我们比较了20例使用SA药物洗脱支架（DESs）进行CTOPCI的患者与20例使用球囊扩张（BE）-DESs进行CTOPCI的对照组患者。所有患者均临床随访12个月，随访期末行冠状动脉造影光学相干断层扫描。主要终点是支架支柱贴壁不良和支柱覆盖。次要终点是12个月时的复合主要不良心血管事件（MACEs）。
结果：两组的糖尿病患病率都很高，大多数治疗的病变都很复杂，62%的患者J-CTO评分≥3分。所有CTOPCI技术都允许进行再通，75%的手术由血管内超声引导。12个月时,SA-DES组贴壁不良支柱较少(0%[四分位距(IQR)0%-0%]vs4.5%[IQR0%-20%];p<0.001),未覆盖支柱(0.08%[IQR0%-1.6%]vs8.2%[IQR0%-16%];p<0.001).然而,他们显示,由于临床驱动的靶病变血运重建,MACE的发生率显著较高(45%vs15%;p=0.038).
结论：在这项初步研究中，与传统的BE-DES相比，CTOPCI中使用的SA-DES与较少的贴壁不良和未覆盖的支架支柱相关，但支架内再狭窄和MACE发生率明显较高。主要由临床驱动的靶病变血运重建引起。
