应用光学相干断层成像技术观察药物支架微小贴壁不良  

Accessment of minimal incomplete stent apposition after implanted drug-eluting stents by OCT

作　　者：杨光[1] 马丹[1] 刘洋[1] 郑志磊[1] 王鑫伟[1] 杜洪伟[1] 李腾 于波[1] 杨爽[1] 

机构地区：[1]哈尔滨医科大学附属第二医院心血管内科,黑龙江哈尔滨150081 [2]齐齐哈尔市中医医院心血管内科,黑龙江齐齐哈尔161000

出　　处：《哈尔滨医科大学学报》2015年第4期321-323,共3页Journal of Harbin Medical University

基　　金：黑龙江省卫生厅医学科学研究课题(2012-604)

摘　　要：目的通过光学相干断层成像技术(optical coherence tomography,OCT)对药物洗脱支架(drugeluting stent,DES)植入后微小贴壁不良的转归进行观察。方法 29例植入DES后应用血管内超声(intravascular ultrasound,IVUS)检测未发现贴壁不良而应用OCT观察到微小贴壁不良的冠心病患者,术后6个月行OCT复查,观察DES植入后微小贴壁不良的面积大小、贴壁不良处内膜覆盖情况等,评价微小贴壁不良的变化。结果应用OCT于术后即刻检测了29例冠心病患者,其中有31枚支架存微小贴壁不良。6个月随访时每枚支架的贴壁不良小梁数及支架小梁贴壁不良率分别由34±12及13.4%±8.6%降至6±2及4.0%±1.1%(P均<0.05),平均贴壁不良面积和最大贴壁不良面积分别由(0.37±0.15)mm2及(0.58±0.14)mm2降至(0.09±0.04)mm2及(0.17±0.07)mm2(P均<0.05)。而支架新生内膜平均厚度及平均内膜面积差异均无统计学意义。结论应用OCT能够观察到IVUS检测不到的微小贴壁不良;在6个月时,大部分DES微小贴壁不良消失,但少数仍持续存在。Objective To access the fate of minimal incomplete stent apposition after drug-elu- ting stents （DESs） implanted by optical coherence tomography （OCT）. Methods Twenty- nine patients who had been implanted DESs underwent evaluation of stents deployment with IVUS and OCT after procedure. All of these stents can not be detected the minimal incomplete stent apposition by IVUS, but be visualized by OCT. At 6-month follow-up, the changes of the minimal incomplete stent apposition were accessed by OCT, which included the area of stent malapposition and the conditions of neointima by OCT. Results Totally 31 stents from 29 patients which had minimal incomplete stent apposition were accesed by OCT at 6-month follow- up. Compared with post-procedure, the number and the percent of struts with minimal incomplete stent apposition decreased from 34 ±12 and 13.4% ± 8.6% to 6 ±2 and 4. 0% ± 1.1% respectively （P 〈 0.05 ）. And the mean and maximum extra-stent area also decreased from （0.37±0. 15）mm2 and （0.58 ±0. 14） mm2 to （0. 09 ±0. 04） mm2 and （0. 17±0.07） mm2 respectively compared with post-procedure （P 〈 0.05 ）. There was no Significant difference in mean neointima area and depth at 6-month follow-up. Conclusion OCT can find minimal in- eomplete stent apposition which IVUS can not detect; the most of the minimal incomplete stent apposition can heal at 6-month follow-up, but others persistently exist.

关 键 词：药物洗脱支架 支架贴壁不良 光学相干断层成像 血管内超声 

分 类 号：R318.1[医药卫生—生物医学工程]