스텐트 재협착 병변에서 약물코팅 풍선카테터과 약물용출 스텐트의 예후 분석 = Prognostic Analysis of Drug-Eluting Balloon Catheter and Drug-Eluting Stent for In-Stent Restenosis of Drug-Eluting Stent

국문 초록 (Abstract)

약물용출 스텐트(drug-eluting stents, DES)는 일반 금속 스텐트에 비하여 재협착을 현저하게 줄였지만, 여전히 관상동맥 스텐트 재협착은 비율이 높다. 2012년 11월부터 2016년 12월까지의 일 대학교병원 심혈관센터에서 경피적 관상동맥 스텐트 삽입술 후 관상동맥 조영술에서 스텐트 재협착 환자 187명 그룹 I (약물코팅 풍선카테터 사용, n=127명), 그룹 II (약물용출 스텐트 사용, n=60명)로 분류하여 치료효과, 주요심장사건, 사망 발생률, 심근경색, 표적병변 재개통술 그리고 스텐트 혈전등을 2년 동안 추적 분석하였다. 임상적 특성는 두 그룹간 차이는 없었고(21.1 ± 5.3 vs. 25.3 ± 9.6 mm, p<0.002), 혈관조영검사에서 약물코팅 풍선카테터 사용 그룹에서 스텐트 재협착 길이가 짧았다. 주요심장사건은 8.7%vs.10.0%, p=0.789, 사망발생률0%vs.0%,p=1.000, 심근경색 1.6%vs.6.7%, p=0.085, 표적병변 재개통술 8.7% vs. 10.0%, p=0.789 그리고 스텐트 혈전증 0% vs. 0%, p=1000에서 양군 간에 차이를 보이지 않았다. 약물코팅 풍선카테터가 약물방출 스텐트와 비교하여 2년 추적 검사 결과 주요심장사건에서 차이가 없었고, 약물코팅 풍선카테터는 스텐트 재협착 병변에서 약물방출 스텐트와 함께 선택할 수 있는 좋은 치료방법이라고 사료된다.

다국어 초록 (Multilingual Abstract)

Although the development of Drug-eluting stent (DES) improved the ISR significantly more than the Bare metal stent (BMS), the coronary stent restenosis (ISR) treatment still has a high recurrence rate. This study is compared the efficacy of DEB with that of DES implantation in patients with ISR. Among 4,316 patients who underwent coronary stent implantation at the Chonnam National University Hospital between November 2012 and December 2016, 187 patients developed ISR on follow-up coronary angiography (66.3 ± 11.0 years, 123 males) were enrolled and divided into two groups according to revascularization method as group I (DEB group; n= 127) and group II (DES group; n= 60). Primary end point was defined as major adverse cardiac events (MACEs), composite of cardiac death (CD), myocardial infaction (MI), target lesion revascularization (TLR) and stent thrombosis (ST) during two-year follow-up between the two groups. There were no differences in the baseline characteristics and angiographic findings except that prevalence of device length was shorter (21.1 ± 5.3 vs. 25.3 ± 9.6 mm, p<0.002) in group I.Two-year MACE were not different in the two groups (8.7%vs.10.0%, p=0.789). The incidences of cardiac death (0%vs.0%, p=1.000), MI (1.6%vs.6.7%, p=0.085), TLR(8.7% vs. 10.0%, p=0.789) and ST (0% vs. 0%, p=1000). DEB demonstrated comparable risk reduction for MACEs compared with DES in patients with ISR during two-year follow-up. DEB might be good alternative for the treatment of ISR in patients with ISR

참고문헌 (Reference)

1 김인수, "약물용출 스텐트를 이용한 관상동맥중재술 후 재협착의 독립적 예측인자에 관한 연구 : MDCT calcium-scoring 시행 환자 대상으로" 대한방사선과학회 33 (33): 37-44, 2010

2 김인수, "약물방출 관상동맥 스텐트 시술 후 스텐트 혈전증 발생 환자의 임상경과" 한국콘텐츠학회 13 (13): 880-892, 2013

3 이상록, "국소형 관상동맥 스텐트 재협착 병변에 대한 Cutting Balloon Angioplasty와 약물 용출 스텐트의 임상 효과" 대한심장학회 36 (36): 279-284, 2006

4 Scheller B, "Two year follow-up after treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter" 97 (97): 773-778, 2008

5 Radke PW, "Treatment of in-stent restenosis using a paclitaxel-eluting stent : Acute results and long-term follow-up of a matched-pair comparison with intracoronary betaradiation therapy" 25 (25): 920-925, 2004

6 Scheller B, "Treatment of coronary in-stent restenosis with a paclitaxel-coated balloon catheter" 355 (355): 2113-2124, 2006

7 Dussaillant GR, "Small stent size and intimal hyperplasia contribute to restenosis : A volumetric intravascular ultrasound analysis" 26 (26): 720-724, 1995

8 Holmes DR Jr, "Sirolimus-eluting stents vs. vascular brachytherapy for in-stent restenosis within bare-metal stents : The SISR randomized trial" 295 (295): 1264-1273, 2006

9 Kastrati A, "Sirolimus-eluting stent or paclitaxel-eluting stent vs. balloon angioplasty for prevention of recurrences in patients with coronary in-stent restenosis : A randomized controlled trial" 293 (293): 165-171, 2005

10 Saia F, "Routine sirolimus eluting stent implantation for unselected in-stent restenosis; Insights from the rapamycin eluting stent evaluated at Rotterdam Cardiology Hospital (Research) registry" 90 (90): 1183-1188, 2004

11 Mehilli J, "Randomized trial of paclitaxel versus sirolimus-eluting stents for treatment of coronary restenosis in sirolimus-eluting stents: the ISAR-DESIRE 2 (Intracoronary Stenting and Angiographic Results: Drug Eluting Stents for InStent Restenosis 2) study" 55 (55): 2710-2716, 2010

12 Hoffmann R, "Patterns and mechanisms of in-stent restenosis : A serial intravascular ultrasound study" 94 (94): 1247-1254, 1996

13 Dibra A, "Paclitaxel-eluting or sirolimus-eluting stents to prevent restenosis in diabetic patients" 353 (353): 663-670, 2005

14 Scheller B, "Paclitaxel balloon coating, a novel method for prevention and therapy of restenosis" 110 (110): 810-814, 2004

15 B. Scheller, "Opportunities and limitations of drug-coated balloons in interventional therapies" 36 (36): 232-239, 2011

16 Mishkel GJ, "Long-term outcomes after management of restenosis or thrombosis of drug-eluting stents" 49 (49): 181-184, 2007

17 J. E. Sousa, "Lack of neointimal proliferation after implantation of sirolimus-coated stents in human coronary arteries : a quantitative coronary angiography and threedimensional intravascular ultrasound study" 103 (103): 192-195, 2001

18 Habara S, "Effectiveness of paclitaxel-eluting balloon catheter in patients with sirolimus-eluting stent restenosis" 4 (4): 149-154, 2011

19 Stone GW, "Comparison of a polymer-based paclitaxel-eluting stent with a bare metal stent in patients with complex coronary artery disease a randomized controlled trial" 294 (294): 1215-1223, 2005

20 Mehran R, "Angiographic patterns of in-stent restenosis Classification and implications for long-term outcome" 100 (100): 1872-1878, 1999

21 Rittger H, "A randomized, multicenter, single-blinded trial comparing paclitaxel-coated balloon angioplasty with plain balloon angioplasty in drug-eluting stent restenosis,The PEPCAD-DES study" 59 (59): 1377-1382, 2012

22 Marie-Claude Morice, "A randomized comparison of a sirolimus-eluting stent with a standard stent for coronary revascularization" 346 (346): 1773-1780, 2002

23 Stone GW, "A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease" 350 (350): 221-231, 2004