血管内イメージングによる冠動脈ステント留置後長期成績の予測

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  • The importance of intracoronary imaging when we speculate long-term outcome of new intracoronary stents

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Although long-term rather than short-term efficacy of new coronary stents is very important for patients, it is usually evaluated by the one-year results of randomized comparison trials. When Cypher-sirolimus-eluting stent (C-SES) was compared with Endeavor-zotarolimus-eluting stent (E-ZES), one-year results was significantly better for C-SES; however, the 5-year results was significantly better for E-ZES due to the higher event rate in C-SES after one year. Although the angioscopic images of those stents at one year demonstrated better neointimal coverage in E-ZES than in C-SES and suggested higher risk of complications in C-SES than in E-ZES, many interventionists preferred C-SES than E-ZES in the real world. A major mechanism of very-late drug-eluting stent (DES) failure has been regarded as neoatherosclerosis or atherosclerosis progression. Therefore, the formation of yellow plaque and its disruption may be the mechanism from the angioscopic viewpoint. C-SES is known to accelerate the formation of yellow plaque and E-ZES is known to reduce the yellow color by the formation of thick white neointima, while new DES like Xience-everolimus-eluting stent does not change the yellow color of the original vessel wall. We believe the information coming from the imaging studies should be paid more attention when we speculate the long-term outcome of new stents until the real long-term outcome data become available.

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