冠状动脉光学相干断层成像观察的重度钙化病变形态特点对支架膨胀不良的影响  

Impact of the morphology characteristics of calcified lesions assessed by optical coherence tomography on stent underexpansion

作　　者：汤喆[1,2] 白静 薛令合[3] 杨学东[1] 王蔚然[1] 聂绍平[2] 王禹[1] TANG Zhe;BAI Jing;XUE Ling-he;YANG Xue-dong;WANG Wei-ran;NIE Shao-ping;WANG Yu(Cardiology Department,Chinese PLA General Hospital,Beijing 100853,China)

机构地区：[1]中国人民解放军总医院心血管内科,北京100853 [2]首都医科大学附属北京安贞医院急诊危重症中心 [3]山东省威海市立医院急诊科

出　　处：《中国介入心脏病学杂志》2018年第10期577-583,共7页Chinese Journal of Interventional Cardiology

摘　　要：目的探讨冠状动脉光学相干断层成像(OCT)观察的重度钙化病变预处理后斑块形态学特点,对支架膨胀不良的影响。方法 2016年12月至2017年12月在中国人民解放军总医院心内科行冠状动脉旋磨术联合切割球囊成形术的重度钙化病变患者9例。对9个相关缺血病变均于旋磨联合切割预处理和支架置入后行OCT检查,记录最小管腔面积、钙化弧度、钙化长度、钙化厚度、钙化组织表面组织厚度、钙化环断裂、钙化小结、支架置入后支架面积、支架膨胀率、贴壁情况以及组织脱垂情况。2 mm为一病变节段,共收集148个病变节段,其中105个钙化节段。分析影响支架膨胀不良,贴壁不良的因素以及钙化环断裂的相关因素。结果多因素Logistic回归分析显示,最小管腔面积是支架膨胀不良的主要危险因素(OR 1.870,95%CI 1.021～3.425),而钙化环断裂是支架膨胀不良的保护因素(OR 0.160,95%CI 0.050～0.516)。钙化弧度是影响支架贴壁不良的主要预测因素(OR 1.006,95%CI1.001～1.011)。钙化表面组织厚度(OR0.000, 95%CI0.000～0.001)以及钙化弧度(OR 1.008, 95%CI1.002～1.015)是钙化环断裂的主要预测因素。在105例钙化节段中,按钙化表面组织厚度分组,厚度≤0.1mm钙化节段组47个和厚度> 0.1mm钙化节段组58个。厚度≤0.1mm钙化节段组中,钙化断裂的比例(76.6%)明显高于厚度> 0.1 mm钙化节段组(10.3%),差异有统计学意义(P <0.001)。结论重度钙化病变预处理后,钙化环断裂以及管腔面积的增加,可能有助于支架良好膨胀。有较大钙化弧度、表面组织薄的钙化环,经过旋磨联合切割预处理,易于出现钙化环的断裂。Objective To explore the impact of morphology characteristics of calcified lesions assessed by optical coherence tomography(OCT)on stent underexpansion.Methods Nine patients of coronary heart disease with 9 severe calcified lesions admitted in the Chinese PLA General Hospital f rom December 2016 to December 2017 were included in this study.These 9 ischemia related lesions were all treated by rotational atherectomy(RA)followed by cutting balloon(CB).OCT examination was performed after the plaque preparation and stent implantation,recording the minimum cross sectional lumen area(CSA),calcification arc,calcification length,calcification thickness,and the thickness of sof t tissue over the calcified area.Af ter stent implantation,the minimum stent area,presence of any stent underexpansion,strut malposition,or tissue prolapse was recorded.The OCT series of these 9 lesions were separated into 148 segments with every 2 mm interval.Multivariate logistic regression was used to determine independent factors associated with the presence of sub-optimal stent expansion and stent malposition.Results The formation of calcium crack(OR 0.160,95%CI 0.050-0.516),and a small lumen area(OR 1.870,95%CI 1.021-3.425)after the plaque preparation were impact factors for stent underexpansion.The calcification arc(OR 1.008,95%CI 1.002-1.015)and the soft tissue thickness(OR 0.000,95%CI 0.000-0.001)on the surface of the calcified area were associated with the formation of calcium crack.Conclusions In severe coronary calcified lesions,the calcium crack after the plaque preparation maybe beneficial for optimal stent expansion.The calcification arc and the soft tissue thickness covering the surface of the calcified area,evaluated by OCT were associated with the appearance of the calcium crack.

关 键 词：冠状动脉钙化 支架膨胀不良 光学相干断层成像 冠状动脉旋磨术 切割球囊成形术 

分 类 号：R541.4[医药卫生—心血管疾病]