光学相干断层成像纵向评估颈动脉支架置入后组织脱垂  

Longitudinal evaluation of tissue prolapse after carotid stenting by optical coherence tomography

作　　者：施璇 韩云飞 许晓慧 杨晴雯 王芳 殷勤 刘锐 刘新峰 Shi Xuan;Han Yunfei;Xu Xiaohui;Yang Qingwen;Wang Fang;Yin Qin;Liu Rui;Liu Xinfeng(Department of Neurology,Nanjing Jinling Hospital,Affiliated Hospital of Medical School,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,南京210002 [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,南京210002

出　　处：《中华神经科杂志》2024年第8期848-858,共11页Chinese Journal of Neurology

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

摘　　要：目的利用光学相干断层成像(OCT)评估颈动脉支架置入术后组织脱垂的特征,分析不同组织脱垂类型与临床特征、术前斑块形态的相关性,并随访支架内新生内膜增生(NIH)情况。方法收集2018年7月至2019年12月于南京大学医学院附属金陵医院(东部战区总医院)神经内科行颈内动脉支架置入术和手术前后OCT评估的病例。通过OCT评估术前斑块特征与术后即刻组织脱垂性质。根据组织脱垂性质分成平滑组织脱垂(STP)和不规则和(或)伴有强衰减信号的组织脱垂(I/HTP)两类。分析I/HTP与临床特征、术前斑块特征间的相关性,并总结NIH情况。结果共纳入29例患者,其中23例(79.3%)伴有组织脱垂,包括9例伴有I/HTP、14例伴有STP。相较STP病变,伴有I/HTP的病变更多为富脂斑块(7/9比2/14,P=0.007),且多伴有斑块破裂(7/9比4/14,P=0.036)。此外,伴有I/HTP病变的组织脱垂纵向总长度相较STP病变似乎更长,但差异无统计学意义[3.0(1.5,4.6)mm比1.1(0.7,3.2)mm,Z=1.294,P=0.201]。共6例患者接受OCT随访,平均随访6.7个月,其中3例的I/HTP病变均发生重度异质型NIH(50.1%~61.8%),而1例的STP病变和2例的没有组织脱垂的病变仅有轻度NIH。结论I/HTP相较STP更常出现在具有较大脂质核心和(或)纤维帽破裂的病变中,提示两者形成机制及预后可能不同,需大样本研究进一步论证。Objective To assess the prevalence and type of tissue prolapse(TP)occurring after endovascular treatment(ET),investigate the association between TP types and plaque morphological characteristics before ET,and observe in-stent neointimal hyperplasia(NIH)using optical coherence tomography(OCT).Methods Patients who underwent carotid artery stenting and received pre-and post-ET OCT assessment at Jinling Hospital between July 2018 and December 2019 were collected.Baseline plaque characteristics and TP features were evaluated using OCT.The TPs were classified into two categories:smooth TP(STP)and irregular and/or high attenuated TP(I/HTP).The association between I/HTP and plaque characteristics was analyzed,while NIH feature was also summarized.Results A total of 29 patients were included in the study,of whom 23 patients(79.3%)presented with TP.Among these 23 patients,9 were classified as I/HTP and 14 were classified as STP.Compared with STP,I/HTP was more commonly observed in lipid-rich plaques(7/9 vs 2/14,P=0.007),and lesions with cap rupture(7/9 vs 4/14,P=0.036).Additionally,the longitudinal length of TP appeared to be longer in cases with I/HTP compared to those with STP[3.0(1.5,4.6)mm vs 1.1(0.7,3.2)mm,Z=1.294,P=0.201].Six patients underwent OCT follow-up for a mean duration of 6.7 months,of whom 3 patients with I/HTP showed severe heterogeneous NIH(50.1%-61.8%),while 1 patient with STP and 2 patients without TP only demonstrated mild NIH.Conclusions The study observed that I/HTP was commonly found in plaques with larger lipid core and/or cap rupture,and suggested a potential relationship between I/HTP and NIH.These preliminary findings obtained from a limited sample should be verified by prospective large-scale studies.

关 键 词：体层摄影术 光学相干 颈动脉 组织脱垂 支架 新生内膜增生 

分 类 号：R654.3[医药卫生—外科学]