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STENT TASARIMI, UZUNLUĞU VE ÇAPININ STENT İÇİ RESTENOZ ŞEKİLLERİNE OLAN ETKİSİ

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2003

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
The Relationship Between the patterns of in stent restenosis and stent type, stent diameter and length of the stent. The reasons for differences among locations of the neoinümal proliferative response to implanted stents are unknown. Intrinsic patient related factors and design of the stent seem to be responsible for different patterns of in-stent restenosis (ISR). The angiograp-hic presentation of ISR may provide prognostic information on subsequent target vessel revas-culariz'ation. The aim of this study was to investigate the relationship betwecn the patterns of ISR and stent type, stent diameter and length of the stent. Seventy two ISR patients were İnclu-ded in this study. ISR was angiographically defined as more than 50% narrowing in the stented segment. The patterns of ISR have been categorised as follows: focal (pattern I), diffuse proli-ferative (pattern II) and totai occiusive (pattern III). Two different types of stent were compa-red: Coil (Cook stent) (n= 41) and tubular (NIR stent) (n= 31). Pattern I was found in 37% of patients (n=27), pattern II in 51% (n-37) and pattern III in 11% (n=8). In the coil-stent group, pattern I presented 34% of restenotic lesions, pattern II 56% and pattern III 10%. In the tubu-lar-stem group, pattern I presented 41% of restenotic lesions, pattern II 45% and III 13%. Although coil-stent group tends to be more frequenrly presented with pattern II, this was not statisücally significant. But there was a statistically significant correlation between the diameter and length of the stent and the patterns of ISR (p<0.04, p<0.0l). With decreasing diameter and İncreasing the length of the stent, ISR presented significantly more frequently with pattern II and III. In conelusion, although patterns of ISR do not scem to be influenced by stent design, the diameter and length of the stent is strongly associated with the pattern of ISR.
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Abstract (Original Language): 
İmplanle edilmiş stente karşı gelişen neoinümal prolifcrasyonun stent içi lokalizasyonundaki farklılıklara yol açan faktörler net olarak bilinmemektedir. Stent içi restenozunun (SR) farklı patternlerde ortaya çıkmasından sorumlu olan faktörler arasında stente ait özellikler de (stent dizaynı, boyu, çapı) yer alabilir. SR'nun anjiyografik presentasyon şekli sonraki girİşİmsel tedavi yönteminin türü hakkında da yol gösterici olabilir. Bu çalışmanın amacı SR'nun paterni ile stent dizaynı, çapı ve uzunluğu arasındaki ilişkinin araştırılmasıdır. Bu çalışmaya SR olan 72 hasta (72 lezyon) dahil edildi. SR anjiyografik olarak, 6 ay sonra yapılmış olan kontrol anjiyog-rafide stent içerisinde > %50 darlık olması şeklinde tanımlandı. SR paternleri şu şekilde sınıflandırıldı: tip I: "Foka!" SR: stent içi, proksimal veya distal uçta veya eklem bölgesinde ve u¬zunluğu < 10 mm olan restenotik lezyon, tip II: "Diffuz" SR: genellikle tüm stent içi bölgeyi kaplamış veya stent dışı bölgeye uzanmış ve uzunluğu >10 mm olan restenotik lezyon, tip Di : "total oklüzyon": TTMI (liırombolysis in myocardial infaretion) 0 derecede akımı olan lezyon. İki farklı iip stent karşılaştırıldı: Kıvrımlı stent (n=41) ve tubuler stent (n=31). Hastaların %37'sinde (n=27) tip I, %5 l'inde (n=37) ıtp II ve %1 l'inde (n= 8) tip III SR tespit edildi. Kıvrımlı stent grubundaki restenotik lezyonların %34'ünde tip I, %56'sında tip II ve %10'nunda tip III SR saptandı. Tubuler stent grubunda tip I %41 sıklıkla, tip 11 %45 sıklıkla ve tip III SR % 13 sıklıkla tespit edildi. Kıvrımlı stentlerde daha çok diffüz tipte (tip E) SR eğilimi saptanmak İle birlikte bu farklılık istatistİkİ olarak anlamlı bulunmadı (p=0.07). Fakat stent boyu ve çapı ile SR'nun tipi arasındaki ilişkiler anlamlıydı (sırasıyla, p<0.01 ve p<0.04) Stent çapındaki azalma ve boyundaki artış ile birlikte sıklıkla tip II ve tip III SR patentlerine rastlandı. Sonuç olarak, stent içi restenozunun paterni stent dizaynı ile ilişkili değil gibi görünse de stentin çapı ve boyu ile SR'nun paterni arasında anlamlı İlişkiler saptandı. Kullanılan stent çapının azalması ve boyunun artışı ile birlikte sıklıkla diffüz tipte ve total oklüzyon tarzında SR ile karşılaşıldı.
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