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Angioscopic Findings of Neointimal Coverage Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent Implantationafter Drug Eluting Stent ImplantationShinsuke Nanto,M.D.,PhD.Department of Advanced Cardiovascular TherapeuticsOsaka University Graduate School of MedicineAngioscopic Findings of NeointLate thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapyMcFadden EP,Serryus PW et al.Lancet 2004On 442 days of DES implantation,the patient developed AMI one week after aspirin was discontinued because of surgical therapy of colon carcinoma.Pre procedureStent implantationPost procedureLate stent thrombosisLate thrombosis in drug-elutinFactors of Stent ThrombosisCoronary blood flowMultiple stentingProcedure Related FactorsMorphometric abnormalities(Underexpansion,Asymmetry?)Molphologic abnormalities(Dissection,Incomplete appositionThrombus,Tissue protrusion)Mechanical vessel injuryAnti-thrombotic therapyBiocompatibilityPatient/Lesion factorsVessel size,Lesion lengthAcute coronary syndromePlaque characteristicsLocal plt/coagulation activityLeft ventricular functionResistance for drugsStent ThrombogenisityMaterialDesignsSurface coatingAdjunctive therapeutic agents(drug,Radiation)Honda Y and Fitzgerald PJ.Circulation 2003;108.Factors of Stent ThrombosisCorAngioscopic Findings of Neointimal Coverage after Drug Eluting Stent ImplantationCoronary angioscplyVecmova NEO(FiberTech,Tokyo,Japan)Angioscopic Findings of NeoinClassification of Angioscopic FindingsGrade 0Grade 1Grade 2Grade Grade 0Grade 0:struts were exposed similarly to the time of implantation:struts were exposed similarly to the time of implantationGrade 1Grade 1:struts were covered,but not embedded:struts were covered,but not embeddedGrade 2Grade 2:struts were embedded by the neo-intima,but translucency seen:struts were embedded by the neo-intima,but translucency seenGrade 3Grade 3:struts were fully embedded and invisible by angioscopy:struts were fully embedded and invisible by angioscopyKotani J,Awata M,Nanto S,et al.JACC.2006Kotani J,Awata M,Nanto S,et al.JACC.2006Classification of Angioscopic Neointimal Coverage Grades 3 to 6 Months After Stent Implantation0255075100Bare-Metal Stent(n=22)Bare-Metal Stent(n=22)(%)1007550250Incomplete coverage Incomplete coverage Sirolimus-Eluting Stent(n=15)Sirolimus-Eluting Stent(n=15)Complete coverageGrade 3Grade 3Grade 2Grade 2Grade 1Grade 1Grade 0Grade 0Kotani J,Awata M,Nanto S,et al.JACC.2006Kotani J,Awata M,Nanto S,et al.JACC.2006Neointimal Coverage Grades 3 Representative Cases:BMS vs.SESBare-metal stent(BMS)Sirolimus-eluting stent(SES)(Grade 3)(Grade 1)Stent:Cypher 3.518mmLocation:RCA mid3.7 months f-upStent:Bx Velocity 3.523mmLocation:LAD mid2.7 months f-upRepresentative Cases:BMS vs.A Case implanted both BMS and DESFollow up 3.7 monthsBx Verocity 3.01859 y.o.female Cypher 3.518A Case implanted both BMS and 12 months12 months24 months24 months monthsmonthsChanges in Neointimal Coverage GradeAwata M,Kotani J,Nanto S et al.Circulation.2007Awata M,Kotani J,Nanto S et al.Circulation.200712 months24 months monthsChanComparison of Angioscopic FindingsSES versus PES at 8 Months Thirty Thirty PESPES were were angioscopically compared with angioscopically compared with 36 36 SESSES.Intra-and inter-stent Intra-and inter-stent heterogeneinty of neointimal heterogeneinty of neointimal coverage were more coverage were more common in PES.common in PES.Incidence of thrombi and Incidence of thrombi and yellow plaques were similar yellow plaques were similar between the two groups.between the two groups.Awata M,Nanto S et al.JACC Cardiol Intv 2009Awata M,Nanto S et al.JACC Cardiol Intv 2009Comparison of Angioscopic FindNeointimal Coverage Grades at 8 monthsPES(n=30)PES(n=30)SES(n=36)SES(n=36)Grade0Grade0Grade1Grade1Grade2Grade2Grade3Grade3PESvs.SES:p=0.002byPESvs.SES:p=0.002by22testtest testtest(%)Awata M,Nanto S et al.JACC Cardiol Intv 2009Awata M,Nanto S et al.JACC Cardiol Intv 2009Neointimal Coverage Grades at HomogeneousHomogeneousHeterogeneity of Neointimal Coverage GradesAwata M,Nanto S et al.JACC Cardiol Intv 2009Awata M,Nanto S et al.JACC Cardiol Intv 2009PES vs.SES:p=0.0006 by PES vs.SES:p=0.0006 by 2 2 test testHeterogeneityHeterogeneityof 1 gradeof 1 gradePESPES(n=30)(n=30)SESSES(n=36)(n=36)HeterogeneousHeterogeneous53%47%26%48%26%HomogeneityHomogeneityHeterogeneityHeterogeneityof 2 gradeof 2 grade74%HomogeneousHeterogeneity of NeComparison of Angioscopic FindingsSES versus ZES at 8 MonthsAwata M,Nanto S,et al.JACC.2008Awata M,Nanto S,et al.JACC.2008Cypher 3.523mmCypher 3.523mmEndeavor 3.523mmEndeavor 3.523mmComparison of Angioscopic FindNeointimal Coverage Grades at 8 months(%)Awata M,Nanto S,et al.JACC.2008Awata M,Nanto S,et al.JACC.2008In-stent ate lossIn-stent ate loss -SES=0.07 0.18mm -SES=0.07 0.18mm -ZES=0.51 0.17mm -ZES=0.51 0.17mm （p0.0001p0.0001）Neointimal Coverage Grades atIncidence of Thrombi and Yellow plaques(n=14)(n=14)(n=16)(n=16)P=0.2(n=14)(n=14)(n=16)(n=16)P=0.004ThrombiYellow plaquesIncidence of Thrombi and YelloAngioscopic Findings ZES vs.SES8 mo.after implantation11 mo.after implantationAngioscopic Findings ZES Results of ENDEAVOR-IIIPatient Frequency Distributions of In-segment Late Loss0.130.130.32 0.32 0.340.340.44 0.44 Results of ENDEAVOR-IIIPatientResults of ENDEAVOR-IIIPatient Frequency Distributions of In-segment Late Loss0.130.130.32 0.32 0.340.340.44 0.44 Results of ENDEAVOR-IIIPatientThe Ideal DES Should Have Optimal Late Loss with Narrow Distributions0.130.130.32 0.32 0.340.340.44 0.44 Ideal DESThe Ideal DES Should Have OptSummaryAngiographic findings of DES revealedProlonged delayed growth of neointimaPoor but homogenous covering over SESHeterogeneous luminal surface of PESWhite and homogenous appearance in patients treated with ZES:Basically grade 3 neoinitmaA few yellow plaques and thrombi SummaryAngiographic findings o提问与解答环节Questions And Answers提问与解答环节21谢谢聆听 学习就是为了达到一定目的而努力去干,是为一个目标去战胜各种困难的过程,这个过程会充满压力、痛苦和挫折Learning Is To Achieve A Certain Goal And Work Hard,Is A Process To Overcome Various Difficulties For A Goal谢谢聆听Learning Is To Achieve A C22
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