This study aimed to examine the effect of a mild elevation in serum cholesterol level in a porcine coronary overstretch restenosis model using a balloon angioplasty catheter or drug-eluting coronary stent. Pigs were divided into two groups and were fed a commercial normal diet (CND, n = 4) or a high-fat diet (HFD, n = 4) for 5 weeks. Coronary overstretch injury by balloon angioplasty or stent implantation was induced in the left anterior descending and left circumflex artery after 1 week of feeding. Histopathological analysis was performed at 4 weeks after coronary injury. During the experiment, the total cholesterol level in the HFD group increased by approximately 44.9% (from 65.9 ± 3.21 mg/dL at baseline to 95.5 ± 9.94 mg/dL at 5 weeks). The lumen area in the CND group was reduced in comparison with that in the HFD group after balloon angioplasty. After stent implantation, the injury score showed no significant difference. There were significant differences in the neointimal area (2.7 ± 0.33 mm2 in the CND group vs. 3.3 ± 0.34 mm2 in the HFD group, p<0.05), lumen area (2.6 ± 0.54 mm2 in the CND group vs. 2.0 ± 0.33 mm2 in the HFD group, p<0.05), and percent area stenosis (52.0 ± 7.96% in the CND group vs. 62.4 ± 5.15% in the HFD group, p<0.05). Body weight change was not different between the two groups. Increased serum cholesterol level activated vascular smooth muscle cell proliferation in the porcine coronary overstretch model.

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 (약물코 팅 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 풍선 카테터 사용 그룹에서 스텐트 재협착 길이가 짧았다. 주요심장사건은 8.7%vs.10.0%, p=0.789, 사망발생률 0%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.

Drug-eluting stents (DES) have reduced the rate of restenosis and the need for repeated revascularization of target lesions. However, in stent restenosis is still a major issue and very late stent thrombosis seems to occur more frequently with DES. Recently, incidence of stent thrombosis as a fatal complication has increased and dual antiplatelet therapy is recommended for at least 12 months after implantation. Here we report on a case of ST-segment elevation myocardial infarction due to total occlusion caused by very late stent thrombosis and in stent restenosis simultaneously at 42 months after DES implanta-tion.