FD-OCT在急性冠状动脉综合征介入诊治中的应用研究  

Frequency domain optical coherence tomography in the diagnosis and treatment on percutaneous coronary intervention of acute coronary syndrome

作　　者：张云梅[1] 张宏[1] 赵燕[1] 庞明杰[1] 刘诗琦[1] 周秀莉[1] 丁筱雪[1] 

机构地区：[1]云南省第一人民医院心内科,昆明650032

出　　处：《临床心血管病杂志》2014年第3期219-222,共4页Journal of Clinical Cardiology

摘　　要：目的:评价第2代频域光学相干断层成像(FD-OCT)技术在急性冠状动脉综合征(ACS)介入诊断及治疗的价值及安全性。方法:随机入选ACS患者23例,在冠状动脉(冠脉)造影后进行FD-OCT成像,评价冠脉血管的病变情况,指导冠脉介入治疗(PCI),并在患者支架植入后即刻,用OCT成像系统评价支架释放的情况。结果:23例ACS患者中,不稳定型心绞痛5例,非ST段抬高性心肌梗死12例,ST段抬高性心肌梗死6例;其中5例单纯冠脉造影,1例冠脉内球囊扩张(PTCA),17例行支架植入术;共植入支架28枚,2例为再次支架植入;2例为左主干病变,3例为分叉病变;23例患者30支血管行FD-OCT成像,无严重不良反应。发现斑块破裂16处,纤维斑块10处,脂质斑块16处,易损斑块13处,支架5枚贴壁不良,冠脉内血栓6例,支架内再狭窄2例,支架扩张不全3例,内膜过度增生1例,支架边缘撕裂夹层1处。结论:FD-OCT在ACS患者中应用有良好的操作性及安全性。FD-OCT可清晰显示各种冠脉病变的情况,特别是易损斑块、血栓及支架贴壁情况,可用于指导及评价PCI,弥补冠脉造影的不足。Objective：To evaluate the clinic value and safety of the second generation of frequency domain optical coherence tomography （FD-OCT） in the invention diagnosis and treatment in middle acute coronary syndrome （ACS）. Method：The 23 ACS patients were enrolled randomly. All the patients were underwent FD-OCT during the coronary angiography （CAG） to evaluate the lesion and guide percutaneous coronary intervention （PCI）. Result： Among the 23 ACS patients, 5 had unstable angina pectoris （UAP）, 12 non ST segment elevation myocardial infarction （NSTEMI）, 6 ST segment elevation myocardial infarction （AMI）, including 5 CAG alone, 1 percutaneous transluminal coronary angioplasty （PTCA）, 17 Coronary artery stent implantation, 2 the second stent implantation, 2 left main lesion, 2 bifurcation lesion, with totally 28 stents had been implanted. FD-OCT had been taken on 30 artery of all 23 patents, showing 16 plaque ruptures, 10 fibrous plaques, 16 lipid plaques, 13 vulnerable plaques, 5 stent malappositions, 6 stent thrombosis, 2 in-stent restenosis, 3 incompletely stent dilated, 1 intima hyperplasia, 1 stent tearing artery dissection. All the patients were underwent FD-OCT successfully and safely, without any sever adverse reaction. Conclusion：The application of FD-OCT in ACS patients has good operability and safety. FD-OCT could reveal different coronary artery lesions clearly, especially in vulnerable plaques, stent malapposition and stent thrombosis, thus could be used for guiding and evaluating PCI, acting a compensation of CAG.

关 键 词：急性冠状动脉疾病 光学相干断层成像术 经皮冠状动脉介入治疗诊断成像 

分 类 号：R541.4[医药卫生—心血管疾病]