Hüseyin Uğur YAZICI, Utku ŞENOL, Alparslan BİRDANE, Muharrem NASIFOV, Mehman AĞAMALIYEV, Farhad RAEDI, Ömer GÖKTEKİN

İlaç kaplı stent implantasyonunda intravasküler ultrason kullanımının akut tıkanma ve restenoz oranına etkisi

Amaç: Koroner arter hastalığının tedavisinde yaygın olarak kullanılan stentlerle ilgili en büyük problem erkendönemde akut tromboz, geç dönemde ise restenoz gelişimidir. Şimdiye kadar hiçbir girişim stent trombozu (ST)ve stent restenozu (SR) gelişimini tamamıyla engelleyememiştir. Bu çalışmanın amacı ilaç kaplı stent (İKS) implantasyonu sırasında intravasküler ultrasonografi (IVUS) kılavuzluğunun anjiyografik sonuçlar üzerine etkisini araştırmaktır.Yöntemler: Çalışmaya IVUS kılavuzluğunda İKS uygulanan 23 hasta ve IVUS yapılmaksızın direkt anjiyografi kılavuzluğunda İKS uygulanan 23 hasta alındı. Tüm hastaların altıncı ay kontrol anjiyografileri yapıldı. Anjiyografik sonuçlar gruplar arasında karşılaştırıldı. Bulgular: Gruplar arasında temel anjiyografik ve klinik özellikler benzerdi (p >0,05). İşlem sonrası stent içi minimal lümen çapı (SİMLÇ) IVUS yapılanlarda, IVUS ya- pılmayanlardan daha büyüktü (3,2±03. 2,9±0,4, p=0,03). Akut ST, geç lümen kaybı ve SR oranları ise iki grup arasında benzerdi (p>0,05). İntravasküler ultrasonografi yapılanlarda bir olguda SR tespit edilirken, akut ST gözlenmedi. IVUS yapılmayanlarda ise üç hastada SR ve bir hastada akut ST gözlendi. Sonuç: Mevcut çalışma ile gösterildi ki İKS implantasyonu sırasında IVUS kullanımı girişim başarısını artırabilir. İlaç salınımlı stent implantasyonu sırasında IVUS kullanımı işlemi tamamlayıcı bir fonksiyon görebilir.

The effect of intravascular ultrasound usage for the implantation of drug-eluting stent on the rate of acute thrombosis and restenosis

Objective: Major setbacks with the use of stents, which are widely used in the treatment of coronary artery disease, are development of acute thrombosis during early term and restenosis during the long term. No procedures have been able to completely prevent formation of early stent thrombosis (ST) and in-stent restenosis (ISR) up to now. The aim of the present study was to investigate the impact of intravascular ultrasonography (IVUS) guidance on angiographic outcomes of drug eluting stent (DES) implantation. Methods: In this study, we included 23 patients who received DES with the guidance of IVUS and 23 patients receiving the DES without IVUS. The patients were scrutinized for their sixth month control angiographies. The angiographic results were compared between the groups. Results: The basic angiographic and clinical features were similar between the groups (p>0.05). The minimal luminal diameter after the percutaneous intervention was higher in Group I than Group 2 (3.2±0.3. 2.9±0.4, p=0.03). Acute ST, late lumen loss and stent restenosis rates were comparable between the groups (p>0.05). On the other hand, among the patients that did not receive IVUS three patients were presented with stent restenosis (SR) and one patient developed acute ST. Conclusion: The present results indicate that the use of IVUS for the implantation of DES can increase the success rate of the intervention. Consequently, IVUS can be considered as a complementary method during DES implantation.

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1. George, BS, Voorhees, et al. Multicenter investigation of coronary stenting to treat acute or threatened clo- sure after percutaneous transluminal coronary angio- plasty: Clinical and angiographic outcomes. J Am Coll Cardiol 1993;22:135-143.
2. Yazıcı HU, Nasifov M, Mert KU, et al. Succesful treat- ment of spontaneous dissection of the coronary artery by primary percutaneous coronary intervention. J Clin Exp Invest 2011;23:299-303.
3. Işık T, Uyarel H, Ergelen M, et al. Short and long term outcomes of primary angioplasty in patients aged 75 years and over. Dicle Med J 2011;38:189-196.
4. Doğan A, Kozan Ö, Tüzün N. Stent içi restenozunfi- zyopatolojisi ve tedavisi. Türk Kardiyol Dern Arş 2005;33:115-125.
5. Sousa JE, Costa MA, Abizaid AC, et al. Sustained suppression of neointimal proliferation by sirolimus- eluting stents: one-year angiographic and intravascu- lar ultrasound follow-up. Circulation 2001;104:2007- 2011.
6. McDaniel MC, Eshtehardi P, Sawaya FJ, et al. Contem- porary clinical applications of coronary intravascular ultrasound. JACC Cardiovasc Interv 2011;4:1155- 1167.
7. Fujii K, Mintz GS, Kobayashi Y, et al. Contribution of stent underexpansion to recurrence after sirolimus- eluting stent implantation for in-stent restenosis. Cir- culation 2004;109:1085-1088.
8. Ermiş C, Kılıçkap M, Tuzcu M. Koroner ateroskleroz tanisinda damariçi ultrason. Türk Kardiyol Dern Arş 2002;30:254-264.
9. Ata N, Göktekin Ö. Koroner arter hastalıklarında intra- vaskülerultrason uygulaması. Anadolu Kardiyol Derg 2008;8:15-22.
10. Colombo A, Hall P, Nakamura S, et al. Intra coronary stenting without anticoagulation accomplished with intra vascular guidance. Circulation 1995;91:1676- 1688.
11. García-García HM, Gonzalo N, Pawar R, et al. As- sessment of the absorption process following bioab- sorbable everolimus-eluting stent implantation: tem- poral changes in strain values and tissue composition using intravascular ultrasound radiofrequency data analysis. A substudy of the ABSORB clinicalt rial. Euro Intervention 2009;4:443-448.
12. Jeremias A, Görge G, Konorza T, et al.Stepwiseintr avascularultrasound (IVUS) guidance of high-pres- surecoronarystentingdoes not result in an improved acute or long-term outcome: A randomized comparison to “final look” IVUS assessment. Catheter Cardio- vasc Interv 1999;46:135-141.
13. Müller C, Frey AW, Roskamm H, et al. Single device approach to ultrasound-guided percutaneous trans- luminal coronary angioplasty and stenting: initial ex- perience with a combined intracoronary ultrasound/ variable diameter balloon. Cathet Cardiovasc Diagn 1997; 40:393-399.
14. Russo RJ, Silva PD, Teirstein PS, et al. A random- ized controlled trial of angiography versus intravas- cular ultrasound-directed bare-metal coronary stent placement (The AVID Trial). Circ Cardiovasc Intervent 2009;2:113-123.
15. Mintz GS, Pichard AD, Kovach JA, et al. Impact of pre intervention intravascular ultrasound imaging on transcatheter treatment strategies in coronary artery disease. Am J Cardiol 1994;73:423-430.
16. Hoffmann R, Mintz GS, Popma JJ, et al. Treatment of calcified coronary lesions with Palmaz-Schatz stents. An intravascular ultrasound study. Eur Heart J 1998;19:1224-1231.
17. Ishikawa K, Aoyama Y, Hirayama H. Management of drug-eluting stent restenosis. J Invasive Cardiol 2012;24: 78-82.