光学相干断层成像对冠状动脉支架植入后高压球囊后扩张的指导作用

Guiding role of optical coherence tomography for high pressure balloon post-dilated after coronary artery stent implantation

目的评价光学相干断层成像（OCT）在冠状动脉支架植入后高压球囊后扩张的作用。方法回顾性分析2007年7月至2009年7月连续在本研究所住院并行冠状动脉介入治疗的冠心病患者29例，年龄40～77岁，平均（59．2±4．5）岁。按标准方法行冠状动脉造影术及支架植入术，分别在支架命名压扩张和高压球囊后扩张后行OCT检查，分析支架小梁贴壁情况和内膜脱垂及微小夹层的发生情况。结果29例患者均顺利完成OCT检查，围手术期内无心绞痛和心衰并发症的发生。高压球囊后扩张后支架小梁与血管壁的距离（94．00±22．42）μm明显短于支架命名压扩张后的距离（137．38±26．80）μm，差异有统计学意义（P〈0．01）。高压后扩张后内膜脱垂和微小夹层的发生（分别为14处和0处）明显少于支架命名压扩张后内膜脱垂和微小夹层的发生（分别为32处和5处），两者差异均有统计学意义（P〈0．05）。结论OCT对支架植入术后行高压球童后扩张有一定的指导作用。

Objective To evaluate the impact of optical coherence tomography（OCT） for high pressure postdilatation after coronary artery stent implantation. Methods A cohort of 29 consecutive coronary heart disease patients with an average age of （59.2 ±4.5） years （40-77 years） old who had finished pereutaneous coronary intervention from July 2007 to July 2009 were retrospectively analyzed. Coronary angiography and stent implantation were done according to standard methods, and OCT examination was done after stents expanded with named pressure and high pressure balloon post-dilatation respectively, as well as the stent struts apposition,intimal prolapse and micro-dissection were analyzed. Results Twenty-nine patients finished OCT examination successfully without angina and heart failure complications in the surrounding operation stage. The distance between the vessel wall and stent struts of high pressure balloon post-dilatation （94.00±22.42） μm was significantly shorter than that of the stent named expansion （137.38± 26.80） μm,with statistically significant difference （ P 〈0.01）. The incidence of intimal prolapse and micro-dissection with high-pressure balloon post-dilatation （respectively 14 and 0） were significantly less than that of stent named expansion （respectively 32 and 5） ,and both of them had statistic difference （ P 〈0.05）. Conclusion There is a certain guide role of OCT for high pressure balloon post-dilatation after stent implantation.