不同冲洗介质在冠状动脉光学相干断层成像中的应用比较  

Comparison among different flushing media for intracoronary imaging with optical coherence tomography

作　　者：李波[1] 李智博[1] 王金鹏[1] 赵雷[1] 王智慧[1] 武军铎[1] 刘斌[1] Li Bo;Li Zhibo;Wang Jinpeng;Zhao Lei;Wang Zhihui;Wu Junduo;Liu Bin(Department of Cardiology,the Second Hospital of Jilin University,Changchun 130000,China)

机构地区：[1]吉林大学第二医院心血管内科,长春130000

出　　处：《中华心血管病杂志》2024年第2期144-149,共6页Chinese Journal of Cardiology

摘　　要：目的在使用光学相干断层扫描(OCT)指导经皮冠状动脉介入治疗(PCI)过程中,观察造影剂与肝素化生理盐水1∶1混合介质及单纯肝素化生理盐水作为替代介质对OCT成像质量的影响及其安全性。方法本研究为单中心前瞻性队列研究。入选2021年10月至2022年8月在吉林大学第二医院心血管内科行PCI并完成OCT检查的慢性稳定型心绞痛或急性冠脉综合征患者。在病变血管相同位置分别使用造影剂(造影剂组)、造影剂与肝素化生理盐水1∶1混合介质(混合介质组)及单纯肝素化生理盐水(生理盐水组)作为冲洗介质行OCT检查。由独立观察者分析所有影像结果并判断管腔成像质量,以清晰成像区域比例(CIF%)作为评价指标对结果进行定量分析。同时测量血管腔平均直径,对比分析3种冲洗介质成像测量的管腔平均直径,观察3种介质对管腔解剖结构、病变病理特征及支架等的成像质量。结果共入选了105例患者,包括110支靶血管。入选患者年龄为(60.5±8.4)岁,男性60例(57.1%)。3组均未观察到与冲洗介质相关的并发症,且在管腔解剖结构、病变特征及支架相关特征方面显示了相同的图像质量。混合介质组在左右冠状动脉的检查中均达到与造影剂组相当的CIF%[右冠状动脉100.0%(100.0%,100.0%)比100.0%(100.0%,100.0%),P>0.05,左冠状动脉100.0%(95.9%,100.0%)比100.0%(100.0%,100.0%),P>0.05];生理盐水组在对右冠状动脉的检查中,达到与造影剂组相当的CIF%[100.0%(97.6%,100.0%)比100.0%(100.0%,100.0%),P>0.05],而在左冠状动脉CIF%较低[84.9%(75.9%,93.4%)比100.0%(100.0%,100.0%),P<0.05]。对于冠状动脉管腔平均直径的测量,与造影剂组相比,混合介质组及生理盐水组的测量结果在左右冠状动脉的差异均无统计学意义(P>0.05)。结论肝素化生理盐水1∶1混合介质可以替代造影剂在PCI中作为冲洗介质进行OCT检查,单纯生理盐水亦在右冠状动脉OCT检查中有Objective To explore the effects and safety of saline mixed 1∶1 with contrast medium(mixed medium)and pure heparinized saline as alternative media for optimal Optical Coherence Tomography(OCT)guided percutaneous coronary intervention(PCI).Methods This single-center,prospective cohort study enrolled patients who underwent PCI with OCT guidance for chronic stable angina or acute coronary syndrome at the Department of Cardiology,the Second Hospital of Jilin University from October 2021 to August 2022.The target vessels were examined using OCT with three different flushing media at the same anatomical positions:contrast agent,mixed medium,and pure heparinized saline.An independent observer analyzed all imaging results and evaluated the lumen imaging quality,using the proportion of the clear imaging field(CIF%)as a quantitative measure for analysis.The average luminal diameter was compared among different flushing media.The study also assessed the image quality of the luminal anatomical structures,lesion pathologies,and stents.Results A total of 105 patients were enrolled in the study,including 110 target vessels.The age of the enrolled patients was(60.5±8.4)years,with 60 male patients(57.1%).OCT examinations were successfully completed using all three media,and no related complications were observed in any groups.The three flushing media presented with the same image quality in terms of depicting the lumen anatomical structures,lesion characteristics,and stent-related features.The mixed medium group achieved a comparable CIF%to the contrast group with both right and left coronary arteries(right coronary 100.0%(100.0%,100.0%)vs.100.0%(100.0%,100.0%),P>0.05;left coronary 100.0%(95.9%,100.0%)vs.100.0%(100.0%,100.0%),P>0.05).While the saline group reached a comparable CIF% to the contrast group with right coronary arteries(100.0%(97.6%,100.0%)vs.100.0%(95.9%,100.0%),P>0.05)but showed a significantly lower CIF%with left coronary arteries(84.9%(75.9%,93.4%)vs.100.0%(100.0%,100.0%),P<0.05).For the average diameter of the

关 键 词：光学相干断层扫描 造影剂 肝素化生理盐水 腔内影像 

分 类 号：R541.4[医药卫生—心血管疾病]