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Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,2020/9/14,#,Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent Implantation,Shinsuke Nanto, M.D., PhD.,Department of Advanced Cardiovascular Therapeutics,Osaka University Graduate School of Medicine,Angioscopic Findings of Neoint,Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy,McFadden EP, Serryus PW et al. Lancet 2004,On 442 days of DES implantation, the patient developed AMI one week after aspirin was discontinued because of surgical therapy of colon carcinoma.,Pre procedure,Stent implantation,Post procedure,Late stent thrombosis,Late thrombosis in drug-elutin,Factors of Stent Thrombosis,Coronary blood flow,Multiple stenting,Procedure Related Factors,Morphometric abnormalities,(Underexpansion, Asymmetry?),Molphologic abnormalities,(Dissection, Incomplete apposition,Thrombus, Tissue protrusion),Mechanical vessel injury,Anti-thrombotic therapy,Biocompatibility,Patient / Lesion factors,Vessel size, Lesion length,Acute coronary syndrome,Plaque characteristics,Local plt / coagulation activity,Left ventricular function,Resistance for drugs,Stent Thrombogenisity,Material,Designs,Surface coating,Adjunctive therapeutic agents,(drug, Radiation),Honda Y and Fitzgerald PJ. Circulation 2003;108.,Factors of Stent ThrombosisCor,Angioscopic Findings of Neointimal Coverage after Drug Eluting Stent Implantation,Coronary angioscply,Vecmova NEO,(FiberTech, Tokyo, Japan),Angioscopic Findings of Neoin,Classification of Angioscopic Findings,Grade 0,Grade 1,Grade 2,Grade,Grade 0,: struts were exposed similarly to the time of implantation,Grade 1,: struts were covered, but not embedded,Grade 2,: struts were embedded by the neo-intima, but translucency seen,Grade 3,: struts were fully embedded and invisible by angioscopy,Kotani J, Awata M, Nanto S, et al. JACC. 2006,Classification of Angioscopic,Neointimal Coverage Grades,3 to 6 Months After Stent Implantation,0,25,50,75,100,Bare-Metal Stent (n=22),(%),100,75,50,25,0,Incomplete coverage,Sirolimus-Eluting Stent (n=15),Complete coverage,Grade 3,Grade 2,Grade 1,Grade 0,Kotani J, Awata M, Nanto S, et al. JACC. 2006,Neointimal Coverage Grades 3,Representative Cases: BMS vs. SES,Bare-metal stent (BMS) Sirolimus-eluting stent (SES),(Grade 3) (Grade 1),Stent: Cypher 3.518mm,Location: RCA mid,3.7 months f-up,Stent: Bx Velocity 3.523mm,Location: LAD mid,2.7 months f-up,Representative Cases: BMS vs.,A Case implanted both BMS and DES,Follow up 3.7 months,Bx,Verocity 3.0,18,59 y.o. female,Cypher 3.5,18,A Case implanted both BMS and,12 months,24 months,months,Changes in Neointimal Coverage Grade,Awata M, Kotani J, Nanto S et al. Circulation. 2007,12 months24 months monthsChan,Comparison of Angioscopic FindingsSES versus PES at 8 Months,Thirty,PES,were angioscopically compared with 36,SES,.,Intra- and inter-stent heterogeneinty of neointimal coverage were more common in PES.,Incidence of thrombi and yellow plaques were similar between the two groups.,Awata M, Nanto S et al. JACC Cardiol Intv 2009,Comparison of Angioscopic Find,Neointimal Coverage Grades at 8 months,PES (n=30),SES (n=36),Grade 0,Grade 1,Grade 2,Grade 3,PES vs. SES: p=0.002 by ,2,test,test,(%),Awata M, Nanto S et al. JACC Cardiol Intv 2009,Neointimal Coverage Grades at,Homogeneous,Heterogeneity of Neointimal Coverage Grades,Awata M, Nanto S et al. JACC Cardiol Intv 2009,PES vs. SES: p=0.0006 by ,2,test,Heterogeneity,of 1 grade,PES,(n=30),SES,(n=36),Heterogeneous,53%,47%,26%,48%,26%,Homogeneity,Heterogeneity,of 2 grade,74%,HomogeneousHeterogeneity of Ne,Comparison of Angioscopic FindingsSES versus ZES at 8 Months,Awata M, Nanto S, et al. JACC. 2008,Cypher 3.523mm,Endeavor 3.523mm,Comparison of Angioscopic Find,Neointimal Coverage Grades at 8 months,(%),Awata M, Nanto S, et al. JACC. 2008,In-stent ate loss,- SES = 0.07 0.18mm,- ZES = 0.51 0.17mm,（,p0.0001,）,Neointimal Coverage Grades at,Incidence of Thrombi and Yellow plaques,(n=14),(n=16),P=0.2,(n=14),(n=16),P=0.004,Thrombi,Yellow plaques,Incidence of Thrombi and Yello,Angioscopic Findings ZES vs. SES,8 mo. after implantation,11 mo. after implantation,Angioscopic Findings ZES,Results of ENDEAVOR-III,Patient Frequency Distributions,of In-segment Late Loss,0.13,0.32,0.34,0.44,Results of ENDEAVOR-IIIPatient,Results of ENDEAVOR-III,Patient Frequency Distributions,of In-segment Late Loss,0.13,0.32,0.34,0.44,Results of ENDEAVOR-IIIPatient,The Ideal DES Should Have,Optimal Late Loss with Narrow Distributions,0.13,0.32,0.34,0.44,Ideal DES,The Ideal DES Should Have Opt,Summary,Angiographic findings of DES revealed,Prolonged delayed growth of neointima,Poor but homogenous covering over SES,Heterogeneous luminal surface of PES,White and homogenous appearance in patients treated with ZES:,Basically grade 3 neoinitma,A 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,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 C,
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