| Background:Drug-eluting stents (DES) having been widely used in the treatment of CHD. Lots of studies show that DES implantation has demonstrated excellent long-term effects in the prevention of angiographic restenosis as well as improvement in clinical outcomes. However, recent reports have raised concerns that DES implantation may cause delayed endothelialization or endothelial dysfunction of traumatized coronary vessel walls which could result in stent thrombosis. Antiplatelet therapy such as clopidogrel is needed 「to prevent restenosis of the incomplete endothe-lialization group. Several studies have demonstrated that optical coherence tomography (OCT) is able to display endothelialization of the stent struts. But OCT can not be widely used in clinic because of its expensive cost and the possible complications. It is necessary to find a simple and effective and popular methed to reflect endothelialization. Recent studies have shown that von Willebrand Factor(vWF) is one of the most important endothelial dysfunction biomarkers, which plays an essential role in binding platelets to the subendothelium. High level of vWF is related to stent thrombosis.Based on the above, we test plasma vWF level of complete endothe-lialization patients and incomplete endothe-lialization patients and control group, then we analysed the relationship between the uncovered stent struts and the plasma vWF level. We investigated weather vWF factor can predict endothe-lialization of traumatized coronary vessel walls after PCI and guide how long the antiplatelet therapy should be continued.Methods:OCT images were obtained in32diseased coronary vessels with34stents in30patients with coronary artery disease who had no restenosis on follow up angiography at12-18months post DES, of which there were27stents in26LAD and4stents in3LCX and3stents in3RCA. All the stents were Cypher stents. Patients with complete endothe-lialization of the struts were considered as complete endothe-lialization group, patients with incomplete endothe-lialization of the DES struts were groupded as incomplete endothe-lialization group, patients with angiographily diagonased nomal coronary were assignded to control group. All the subjects were drawed fasting blood from elbow venous after admssion, then plasma biochemicals in were tested.After CAG and OCT, the patients were drawed blood from elbow venous, then centrifuge at3000rpm, the plasma were stored at-80℃, and plasma vWF level of the three groups were tested by ELISA. Use lineary correlation analysis to analyze the correlationship between the plasma vWF level and the number of uncovered stent struts. The SPSS15.0program was used for statistical analysis.Results:The plasma vWF level of incomplete endothe-lialization group was significantly higher than the complete endothe-lialization group (29.13±8.47ng/ml vs13.81±1.04ng/ml p<0.05), the plasma vWF level of incomplete endothe-lialization group was significantly higher than the control group (29.13±8.47ng/ml vs12.83±1.13ng/ml p<0.05), complete endothe-lialization group and the control group had no significant differentce in the plasma vWF level(13.81±1.04ng/ml vs12.83±1.13ng/ml p>0.05). Plasma vWF level was positively correlated with the uncovered stent struts.Conclusion:Complete endothe-lialization group and the control group had no significant differentce in the plasma vWF level, the plasma vWF level of incomplete endothe-lialization group was significantly higher than both the complete endothe-lialization group and control group, our study confirms that the plasma vWF level has certain reference value in predicting endothe-lialization of traumatized coronary vessel walls after PCI. The plasma vWF level was positively correlated with the number of uncovered stent struts, the plasma vWF level can guide how long the antiplatelet therapy should be continued for the patients with coronary artery disease who had drug-eluting stent (DES) implanted to some extent. |
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