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AngioscopicFindingsofNeointimalCoverageafterDrugElutingStentImplantationShinsukeNanto,M.D.,PhD.AngioscopicFindingsofNeoint•Mc

FaddenEP,SerryusPWetal.Lancet2004On442daysofDESimplantation,thepatientdevelopedAMIoneweekafteraspirinwasdiscontinuedb

ecauseofsurgicaltherapyofcoloncarcinoma.PreprocedureStentimplantationPostprocedureLatestentthrombosisLatethrombosisi

ndrug-elutinHondaYandFitzgeraldPJ.Circulation2003;108.FactorsofStentThrombosisCorAngioscopicFindingsofNeoin

timalCoverageafterDrugElutingStentImplantationCoronaryangioscply™AngioscopicFindingsofNeoinGrade0Grade1Grade2Grade３QuickTime?遣D

V/DVCPRO-NTSC闘恚蓈社蒓赦赡菣潜敲蓅蒒蒨缮蔷濠侨菫墙菂钦颣髒黔菑臖Grade0:strutswereexposedsimilarlytothetimeofimplantationGrade1:strutswerecovered,butnotem

beddedGrade2:strutswereembeddedbytheneo-intima,buttranslucencyseenGrade3:strutswerefullyembeddedandinvisibl

ebyangioscopyKotaniJ,AwataM,NantoS,etal.JACC.2006ClasificationofAngioscopicNeointimalCoverageGrades3to6MonthsAfterStentI

mplantation0255075100Bare-MetalStent(n=22)(%)1007550250IncompletecoverageSirolimus-ElutingStent(n=15)CompletecoverageGrade

3Grade2Grade1Grade0KotaniJ,AwataM,NantoS,etal.JACC.2006NeointimalCoverageGrades3Stent:Cypher3.5×18mmLocation:RCAmid3.7monthsf-upStent:BxVel

ocity3.5×23mmLocation:LADmid2.7monthsf-upRepresentativeCases:BMSvs.ACaseimplantedbothBMSandBare-metalstentFirstfollow-upSecondfollow-upThirdf

ollow-upNeointimalcoveragegrade0123Sirolimus-elutingstentn=1n=1n=13n=13n=10n=10n=11n=4n=4n=3n=412months24monthsBare-metalstentFirstfollow-upSecondfo

llow-upThirdfollow-upNeointimalcoveragegrade0123Sirolimus-elutingstentn=1n=1n=13n=13n=10n=10n=11n=4n=4n=3n=4４monthsAwataM,KotaniJ,Nanto

Setal.Circulation.200712months24months４monthsChan•ThirtyPESwereangioscopicallycomparedwith36SES.−Intra-

andinter-stentheterogeneintyofneointimalcoverageweremorecommoninPES.−Incidenceofthrombiandyellowplaquesweresimilarbetweenthetwogroups.

AwataM,NantoSetal.JACCCardiolIntv2009ComparisonofAngioscopicFindNeointimalCoverageGradesat8monthsPES(n=30)SES(n=36)Grade

0Grade1Grade2Grade3PESvs.SES:p=0.002byχ2testtest(%)AwataM,NantoSetal.JACCCardiolIntv2009NeointimalCo

verageGradesatHomogeneousAwataM,NantoSetal.JACCCardiolIntv2009PESvs.SES:p=0.0006byχ2testHeterogeneityof1gradePES(n=30)SES(n=

36)Heterogeneous53%47%26%48%26%HomogeneityHeterogeneityof2grade74%HomogeneousHeterogeneityofNeAwataM,NantoS,etal.JACC.2008Cypher3.5×23mmEndeav

or3.5×23mmComparisonofAngioscopicFindNeointimalCoverageGradesat8months(%)AwataM,NantoS,etal.JACC.2008NeointimalCoverageGra

desatIncidenceofThrombiandYellowplaquesP=0.2P=0.004ThrombiYellowplaquesIncidenceofThrombiandYelo8mo.afterimplantatio

n11mo.afterimplantationAngioscopicFindingsZESPatientFrequencyDistributionsofIn-segmentLateLoss051015202530-0.6-0.20.20.61.01.41.

82.22.6InsegmentLL(mm)%ofPatientsEndeavorCypher0.13±0.320.34±0.44ResultsofENDEAVOR-IPatientPatientFrequencyD

istributionsofIn-segmentLateLoss051015202530-0.6-0.20.20.61.01.41.82.22.6InsegmentLL(mm)%ofPatientsEndeavorCypher0.13±0.320.34±0.44

ResultsofENDEAVOR-IPatient051015202530-0.6-0.20.20.61.01.41.82.22.6InsegmentLL(mm)%ofPatientsEndeavorCypher0.

13±0.320.34±0.44IdealDESTheIdealDESShouldHaveOptSummaryAngiographicfindingsofDESrevealed✓Prolongeddelayedgrowthofneointima✓Poorbuthomogenou

scoveringoverSES✓HeterogeneousluminalsurfaceofPES✓WhiteandhomogenousappearanceinpatientstreatedwithZES:Basicallygrad

e3neoinitmaAfewyellowplaquesandthrombiSumaryAngiographicfindingso提问与解答环节QuestionsAndAnswers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LearningIsToAchieveACertainGoalAndWorkHard,IsAProcessToOvercomeVariousDifficultiesForAGoal谢聆听LearningIsToAchieveAC