光学相干断层成像初探颈动脉管腔内血栓特征  

Preliminary evaluation of carotid artery thrombosis by optical coherence tomography

作　　者：施璇 韩云飞 许晓慧 杨晴雯 刘锐 王芳 侯超 殷勤 叶瑞东 刘新峰 Shi Xuan;Han Yunfei;Xu Xiaohui;Yang Qingwen;Liu Rui;Wang Fang;Hou Chao;Yin Qin;Ye Ruidong;Liu Xinfeng(Department of Neurology,Affiliated Jinling Hospital,Medical School of Nanjing University,Nanjing 210002,China;Department of Neurology,Jinling Hospital,the Second Clinical College of Southeast University School of Medicine,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院(东部战区总医院)神经内科,210002 [2]东南大学医学院第二临床学院(东部战区总医院)神经内科,210002

出　　处：《中华神经科杂志》2021年第8期808-815,共8页Chinese Journal of Neurology

基　　金：国家重点研发计划(2017YFC1307901);国家自然科学基金(81530038,81870946,81901218)。

摘　　要：目的利用光学相干断层成像(OCT)观察颈动脉粥样硬化性患者伴有血栓形成的临床与形态学特征。方法评估2017年1月至2020年1月在金陵医院(东部战区总医院)神经内科行颈内动脉窦部OCT检查明确有管腔内血栓形成的12例患者。通过OCT评估血栓类型与血栓评分,测量其血栓长度、面积及体积,并总结其临床特征、斑块形态学特征与临床预后。结果12例患者的OCT显示伴有血栓形成的病变,其中8例为白血栓,2例为红血栓,2例病变中两种血栓类型均存在。OCT血栓评分为1~32分。OCT血栓评分与血栓体积呈正相关(ρ=0.739,P=0.006),与血栓长度呈正相关(ρ=0.932,P<0.001)。所有病变均伴有斑块纤维帽破裂,其中10例病变为薄纤维帽富脂斑块。对12例患者均在OCT评估后行颈动脉支架置入术治疗。平均随访约14.2个月,评估侧血管病变无缺血事件发生或再次血运重建治疗。结论OCT可用以评估颈动脉粥样硬化病变血管内血栓及其形态特征,定量分析其血栓负荷。Objective To identify the morphological features and clinical significance of intra-vascular thrombus in carotid stenosis using optical coherence tomography(OCT).Methods Twelve patients with carotid artery thrombosis detected by OCT assessment in Jinling Hospital between January 2017 and January 2020 were included.Serial area measurements within the athero-thrombotic target lesion were performed to evaluate the OCT-thrombus score,length,area and volume.The clinical data and plaque morphological features were also assessed.Results Among the 12 patients demonstrating thrombus on OCT,eight patients presented with white thrombus,two patients presented with red thrombus,and another two patients displayed both white thrombus and red thrombus.OCT-thrombus scores were 1-32.The OCT-thrombus score was correlated to the OCT-thrombus volume(ρ=0.739,P=0.006)and the thrombus length(ρ=0.932,P<0.001).All lesions were presented with fibrous cap disruption,and 10 lesions were presented with thin-cap fibroatheroma.In view of the OCT findings,all patients received carotid balloon angioplasty and stent implantation.During an average follow-up of 14.2 months,none of the 12 patients had fatal stroke or recurrent ischemic stroke.Conclusions OCT can be used to assess intra-carotid thrombus and its more detailed morphological characteristics,offering more possibilities in quantitative analysis of thrombus burden.

关 键 词：血栓形成 动脉粥样硬化 颈动脉 光学相干断层成像 

分 类 号：R543.4[医药卫生—心血管疾病]