植入药物洗脱支架后晚期获得性贴壁不良的情况  

Late acquired after implantation of drug-eluting stents to stick wall bad happened

作　　者：马丹[1] 杨光[1] 杜洪伟[1] 于波[1] 杨爽[1] 

机构地区：[1]哈尔滨医科大学附属二院心内科,黑龙江哈尔滨150081

出　　处：《哈尔滨医科大学学报》2016年第1期59-62,共4页Journal of Harbin Medical University

摘　　要：目的用光学相干断层成像(optical coherence tomography,OCT)及血管内超声(intravascular ultrasound,IVUS)观察患者植入药物洗脱支架(drug-eluting stent,DES)后1年获得性贴壁不良发生情况,并分析发生机制。方法入选30例植入DES的冠心病患者,分别于术后即刻及术后1年对患者行OCT及IVUS检查。对获得的OCT及IVUS图像进行测量,分析术后1年获得性贴壁不良的发生率,并对比分析术后即刻及术后1年的影像数据,找出发生获得性贴壁不良可能的原因及预后。结果术后1年时对27例患者的32枚DES行OCT及IVUS检查。术后1年时共4枚(12.5%)支架出现获得性贴壁不良,其中贴壁不良处未覆盖的小梁数为12(11.8%),贴壁良好处未覆盖的小梁数为184(3.0%),两者之间有统计学差异(P<0.05);而贴壁不良处新生内膜厚度及新生内膜面积与贴壁良好处两者之间无统计学差异(P>0.05);用IVUS测得术后1年时贴壁不良处的外弹力板面积为(28.1±2.7)mm2,较术后即刻外弹力板面积为(22.9±2.9)mm2明显增大,两者间有统计学差异(P<0.01)。32枚支架均为发现支架内血栓形成。结论用OCT及IVUS可检测出支架术后获得性贴壁不良,获得性贴壁不良可能与支架术后血管正性重构相关。发生获得性贴壁不良的位置有更多的支架小梁未被新生内膜覆盖,可能需延长双重抗血小板治疗时间。Objective To observe the fate of acquired stent malapposition（ ASM） after drugeluting stents（ DESs） impalted by intravascular ultrasound（ IVUS） and optical coherence tomography（ OCT）. Methods Thirty patients who had been implated DESs underwent evaluation of stents deployment with IVUS and OCT post-procedure and at 1 year follow-up. The data of OCT and IVUS images were analysed to the percent of incidence of ASM. And the data of post-procedure and at 1year follow-up were compared to find the cause of ASM forming. Results Totally 32 stents from 27 patients had been accessed by OCT and IVUS at 1 year followup. In these stents,4 stents（ 12. 5%） was found which had ASM. In the ASM group,the percent of uncovered struts was higher than in non-ASM group（ 11. 9% vs 3. 0%,P〈0. 05）;there was no significant difference from both neointima area and depth at 1 year follow-up. The external elastic area in ASM group was higher than that in non-ASM group by IVUS（ 28. 1 mm2± 2. 7 mm2 vs 22. 9 mm2± 2. 9 mm2,P〈0. 01）. In-stent throbus was not found in the 32 stents at 1 year follow-up. Conclusion ASM can be detected by OCT and IVUS. The formation of AST may be caused by vessel positive remodeling. And there are more uncovered struts in the section of ASM,which maybe lead to prolong the dual antiplatelet therapy.

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]