Prospektive randomisierte Untersuchung der Neointimaproliferation in goldbeschichteten Koronarstents im Vergleich zu herkömmlichen Edelstahlstents mittels intravaskulären Ultraschalls

摘要

In-stent restenosis is a major limitation of percutaneous coronary interventions and occurs due to neointimal hyperplasia after stent implantation. Gold coating of stainless stell stents showed an in-vitro-reduction of neointimal formation, an effect attributed to an assumed favourable biocompatibility and reduced thrombogenicity of the element gold. The presented prospective randomised and multicentric study compared the quantitative formation of neointima in diseased human coronary arteries of 204 patients (stainless steel stents n=101, gold coated stents n=103) after placement of stainless steel stents and gold coated stents of identical design, respectively. Evaluation of the anatomical changes of the stented vessel segments was done using intravascular ultrasound (IVUS), a valuable tool for tomographic assessment of vascular stuctures. Baseline parameters did not differ between the groups and procedural success of stent implantation was similar, but after six months IVUS revealed significant differences in neointimal proliferation. By ultrasound, the neointimal volume within the gold coated stents was higher (47 ± 25 vs. 41 ± 23 mm3, p>0,05) as well as the neointimal volume-to-stent volume (0.45 ± 0.12 vs. 0.40 ± 0,12, p>0,01). Thus, gold coating of the tested stent type resulted in mor neointima proliferation.