光学相干断层成像评价冠状动脉内支架术后即刻支架周围组织结构改变  

Peri-Stent Tissue Structural Changes After Coronary Stenting Visualized by Optical Coherence Uomography

作　　者：陈步星[1] 马凤云[1] 罗维[1] 阮剑洪[1] 谢文丽[1] 赵希哲[1] 孙淑红[1] 王枫[1] 郭旭梅[1] 褚晓雯[1] 

机构地区：[1]北京电力医院心内科,100073

出　　处：《中国循环杂志》2007年第4期271-274,共4页Chinese Circulation Journal

摘　　要：目的：应用光学相干断层成像（OCT）评价冠状动脉内支架术后即刻支架周围组织结构改变。方法：对21例临床诊断冠心病准备介入治疗患者，在冠状动脉内置入支架后即刻进行OCT成像检查。21例患者中共有22支冠状动脉置入25个支架，其中前降支11支13个支架，回旋支8支9个支架，右冠状动脉3支3个支架。OCT评价支架贴壁不良、血管夹层及撕裂、组织脱垂等。支架贴壁不良定义为支架支撑杆与血管壁距离大于0．20mm，组织脱垂定义为血管壁组织通过支架网眼突入管腔。结果：21例患者均成功进行OCT检查，22支靶血管25个支架均成功获得清晰OCT图像。通过OCT发现置入的25个支架中有12个支架可以看到部分支架支撑杆未能完全封闭血管壁上的夹层及撕裂；所置入的支架中有50个支架支撑杆贴壁不良，平均支架支撑杆与血管壁的距离为0．39±0．20（0．20-1．16）mm。通过OCT检出置入的25个支架中有20个支架可见到不同程度组织脱垂，共检出85个组织脱垂，平均最大组织脱垂面积为0．55±0．64（0．04～2．81）mm^2。结论：OCT成像技术可清晰显示冠心病冠状动脉支架后血管夹层、撕裂组织脱垂及支架贴壁情况，其临床意义有待于进一步研究。Objective ： To investigate peri-stent tissue structural changes after intracoronary stenting visualized by optical coherence tomography （OCT）. Methods ：OCT images were obtained in 22 diseased coronary vessels and 25 stents in 21 patients with coronary artery disease immediately after coronary stenting. The stented vessels were distributed as follows ： 11 left anterior descending（LAD） lesions, treated with 13 stents;8 left circumflex（LCX） lesions, treated with 9 stents;and 3 right coronary artery （RCA）lesions, treated with 3 stents. The distance between at least one stent strut and the vessel wall equal to or more than 200μm was defined as strut malapposition. Tissue prolapse was defined as protrusion of tissue between stent struts extending inside a circular arc connecting adjacent struts. The strut malposition, vessel dissection or rupture and tissue prolapse after stenting were evaluated by OCT. Results：OCT images were successfully acquired of 22 vessels and 25 stents in 21 patients with coronary artery disease. The OCT images showed that partial coronary artery dissections or ruptures after stenting were not fully covered by the stent struts in 12 of the 25 stents,50 stent struts were found malpositioned, and mean distance between the strut and vessel wall was 0. 39± 0. 20 （0. 20 - 1.16） mm. The OCT images also showed total 85 different tissue prolapses in the 20 stents,and mean maximal area of tissue prolapse was 0. 55 ±0. 64（0. 04-2. 81） mm^2. Conclusions ： OCT imaging can clearly visualized strut malposition, vessel dissection or rupture, and tissue prolapse after coronary stenting. The significances of these findings by OCT shoud be further researched.

关 键 词：冠状动脉疾病 体层摄影术 光学 支架 

分 类 号：R541[医药卫生—心血管疾病]