药物洗脱支架置入术后早期和极晚期支架内再狭窄的光学相干断层成像特点分析  

Analysis of optical coherence tomography of early and very late stent restenosis after drug-eluting stent implantation

作　　者：刘志江[1] 石蓓[1] 邓婵翠 许官学[1] 赵然尊[1] 沈长银[1] 王正龙[1] 刘汉林[1] 

机构地区：[1]遵义医学院附属医院心血管内科,贵州遵义563003

出　　处：《中华医学杂志》2017年第23期1778-1783,共6页National Medical Journal of China

摘　　要：目的应用光学相干断层成像（OCT）评价药物洗脱支架（DES）术后早期支架内再狭窄（E－ISR）与极晚期支架内再狭窄（VL－ISR）病变的形态特征。方法选择2013年7月至2015年12月于遵义医学院附属医院心内科行冠状动脉造影（CAG）检查确诊为ISR （支架植入时间≥8个月）的患者25例行OCT检查，比较E－ISR（〈 1年，n＝14例）和VL－ISR（〉3年，n＝11例）的形态特点。分别对完整支架以及最小管腔位置进行定量与定性分析。再狭窄的OCT定量分析内容：平均管腔面积、平均支架面积、平均新生内膜面积、平均新生内膜负荷；再狭窄的OCT定性分析内容：均质性内膜、异质性内膜（富脂质新生内膜、薄帽纤维粥样斑块）、微血管、管腔内物质（红色血栓、白色血栓）、带腔内膜破裂、组织脱垂。结果完整支架OCT分析显示：异质性内膜（60.57%比32.93%, P＝0.005）、支架周围及内膜内微血管均常见于VL－ISR组（P〈0.05）。此外，VL－ISR组的富脂质新生内膜（72.7%比21.4%, P＝0.017）、薄帽纤维粥样斑块（54.5%比7.1%, P＝0.021）、带腔内膜破裂（63.6%比7.1%, P＝0.007）及管腔内红色血栓发生率（63.6%比7.1%, P＝0.007）均高于E－ISR组。最小管腔位置OCT分析也显示异质性内膜主要见于VL－ISR组（90.9%比35.7%, P＝0.012）；新生内膜内微血管、带腔内膜破裂仅见于VL－ISR组。结论DES植入后OCT成像显示E－ISR与VL－ISR的形态特征不同；新生内膜动脉粥样硬化改变（富脂质新生内膜、薄帽纤维粥样斑块、微血管、带腔内膜破裂）更常见于VL－ISR；DES植入后新生内膜动脉粥样硬化进展可能与VL－ISR有关。Objective Using optical coherence tomography （OCT） to analyze the morphological characteristics of lesions between early in-stent restenosis （E-ISR） and very late in-stent restenosis （VL-ISR） after drug-eluting stents （DES） implantation.Methods In 25 patients （DES） with ISR, OCT images were acquired before percutaneous coronary intervention （PCI）, the morphological characteristics of E-ISR （〈1 years, n=14） and VL-ISR （〉3 years, n=11） were compared.The quantitative and qualitative analysis of the entire stent and the minimum lumen area （MLA） site were carried out respectively. OCT quantitative restenotic tissue analysis included the assessment of mean lumen area, mean stent area, mean neointimal area and mean neointimal burden.OCT qualitative restenotic tissue analysis included the assessment of tissue structure [homogeneous or heterogeneous intima （lipid-rich neoitima, thin-cap fibroatheroma （TCFA）-like intima）], presence of microvessels, intraluminal material （red thrombus, pale thrombus）, disrupted intima with cavity and tissue prolapse and was performed at every 1-mm slice of the entire stent.Results Compared with the E-ISR group, the proportion of cross-sections with heterogeneous intima in the entire stent was significantly higher in the VL-ISR group （60.57% vs 32.93%, P=0.005）, and both peristent and intraintimal microvessels were more frequently observed in the VL-ISR group （P〈0.05）. In addition, lipid-rich neointima （72.7% vs 21.4%, P=0.017）, TCFA-like intima （54.5% vs 7.1%, P=0.021）, disrupted intima with visible cavity （63.6% vs 7.1%, P=0.007） and red thrombus （63.6% vs 7.1%, P=0.007） were observed more frequently in the VL-ISR group compared with E-ISR group for the entire stent.The heterogeneous intima was observed more frequently in the VL-ISR group （90.9% vs 35.7%, P=0.012） at the MLA sites.Intraintimal microvessels and disrupted intima with visible cavity were observed only in the VL-ISR group.Conclusions OCT imaging

关 键 词：药物洗脱支架 光学相干断层成像 支架再狭窄 

分 类 号：R54[医药卫生—心血管疾病]