反复支架内再狭窄的光学相干断层成像病变特征分析  

Optical Coherence Tomography Features of Patients With Recurrent In-stent Restenosis

作　　者：马越 宋雷[1] 黄云飞 袁建松[1] 崔锦钢[1] 胡奉环[1] 杨伟宪[1] 乔树宾[1] MA Yue;SONG Lei;HUANG Yunfei;YUAN Jiansong;CUI Jingang;HU Fenghuan;YANG Weixian;QIAO Shubin(Coronary Heart Disease Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院冠心病中心,北京市100037 [2]中国医学科学院北京协和医学院国家心血管病中心阜外医院介入导管室,北京市100037

出　　处：《中国循环杂志》2022年第2期129-135,共7页Chinese Circulation Journal

基　　金：国家重点研发计划(2018YFB1107102)。

摘　　要：目的:通过光学相干断层成像(OCT)对支架内再狭窄(ISR)患者病变特征进行分析,明确反复支架内再狭窄(R-ISR)及非R-ISR病变发生机制的异同,为进一步指导并优化ISR治疗提供依据。方法:回顾性入选2016年1月至2019年12月于中国医学科学院阜外医院行OCT检查的药物洗脱支架(DES)置入术后ISR患者52例,根据ISR发生次数是否≥2次将患者分为R-ISR组(n=16)和非R-ISR组(n=36),收集患者人口学资料、心血管危险因素、辅助检查、既往介入治疗情况及其他病史资料,对患者冠状动脉造影及OCT图像进行定性、定量分析,比较R-ISR与非R-ISR患者间的差异。结果:R-ISR组与非R-ISR组患者在高血压、高脂血症、糖尿病、吸烟史、冠心病家族史等心血管危险因素方面,及病变位置、ISR分型、参考血管直径、靶病变长度等冠状动脉造影特征方面差异无统计学意义(P均>0.05)。R-ISR病变中均质性新生内膜的比例明显高于非R-ISR病变(43.8%vs.19.4%),且新生动脉粥样硬化的比例明显低于非R-ISR病变(43.8%vs.75.0%),差异具有统计学意义(P均<0.05)。结论:心血管危险因素无差异的情况下,R-ISR患者均质性新生内膜比例更高,支架内纤维增生为R-ISR重要发生机制。Objectives:To clarify the optical coherence tomography(OCT)features of recurrent in-stent restenosis(R-ISR)and non-R-ISR.Methods:A total of 52 patients with ISR after DES implantation who underwent OCT in Fuwai Hospital from January 2016 to December 2019 were retrospectively enrolled,and the patients were divided into R-ISR group(n=16)and non-R-ISR group(n=36).The data on patient demographics,cardiovascular risk factors,ancillary tests,previous interventional treatments,and other medical history were collected and anylyzed.The coronary angiography and OCT images of R-ISR and non-R-ISR patients were analyzed qualitatively and quantitatively.Results:There were no significant differences between R-ISR and non-R-ISR patients in terms of cardiovascular risk factors such as hypertension,hyperlipidemia,diabetes mellitus,smoking history,family history of coronary heart disease.The coronary angiographic characteristics such as lesion location,ISR classification,reference vessel diameter,target lesion length were also similar between the two groups(all P>0.05).The proportion of homogeneous neointima(43.8%)was significantly higher in R-ISR group than in non-R-ISR group(19.4%),and the proportion of neoatherosclerosis(43.8%)was significantly lower in R-ISR group than in non-R-ISR(75.0%,both P<0.05).Conclusions:Our results show the proportion of homogeneous neointima is higher in R-ISR patients,suggesting that enhanced fibroplasia might be an important mechanism of R-ISR.

关 键 词：反复支架内再狭窄 光学相干断层成像 药物洗脱支架 药物涂层球囊 

分 类 号：R54[医药卫生—心血管疾病]