采用光学相干断层成像评价无再狭窄药物洗脱支架内膜增生

Evaluation of endothelialization by optical coherence tomography after drug eluting stent implantion with no restenosis on follow up angiography

目的应用冠状动脉血管内光学相干断层成像技术(optical coherence tomography,OCT)评价造影随访无再狭窄的药物洗脱支架(drug eluting stent,DES)内皮增生情况。方法从北京安贞医院2007年9月至2008年9月连续入选DES术后无症状而接受冠状动脉造影复查无明显再狭窄的患者18例,所有患者接受OCT检查,比较不同的DES植入时间、不同DES组之间,每组支架小梁血管内膜增生情况。结果共分析4709个支架小梁,其中被内皮完全覆盖的支架小梁个数4173个(88.6%),被内皮部分覆盖的个数是33个(0.7%),暴露的小梁个数382个(8.1%);贴壁不良的小梁个数121个(2.6%),覆盖支架小梁的内膜的平均厚度是0.099mm,内膜厚度>100μm的小梁个数2378个(50.5%);不同药物洗脱支架之间内膜增生厚度、支架小梁内膜覆盖及晚期支架贴壁不良差异有统计学意义;与DES植入时间<12个月相比,植入时间12个月血管内膜增生厚度有明显增加趋势(0.1183mm比0.0875mm;P=0.001);支架内膜无覆盖比率分别是:1.7%比6.8%(P<0.05);贴壁不良比率是:2.1%比0.5%(P<0.001)。结论通过OCT分析16个月左右的药物洗脱支架血管内膜厚度,总的来说90.1%的支架小梁有内膜覆盖,但是仍然有高达9.9%的无内膜覆盖,支架类型、支架置入时间之间内膜覆盖、支架贴壁有一定差异;同时支架植入大于12个月的支架贴壁不良比率高于不足12个月的,提示更晚期的支架贴壁不良情况存在,对于药物洗脱支架的随访时间应该更长,双联抗血小板治疗疗程也许应该更长。

Objective To evaluate neointimal coverage by optical coherence tomography（OCT）after Drug Eluting Stent（DES）implantation with no restenosis shown on follow up angiography.Methods Eighteen cases who had received DES implantation between September 2007 to September 2008 and had no restenosis on follow up angiography were enrolled and underwent OCT.Results A total of 4709 struts were analyzed and 88.6% were completely covered with neointimal,0.7% were partially covered and 8.1% were uncovered.The rate of late malposition of struts was 2.6%.The average neointimal hyperplasia thickness was 0.099mm.k The rates of uncovered struts and late stent malposition were different among different types of DES,and so did the average thickness of neointimal hyperplasia.lCompared with DES implantation less than 12 months,the average neointima was thicker in the group of DES implantation more than 12 months（0.1183mm vs 0.0875mm;P =0.001）,and the uncovered strut rates were 1.7% and 6.8% respectively（P 0.05）,while late stent malposition rate were 2.1% and 0.5% respectively（P 0.001）.Conclusion The rate of neointimal coverage over DES at about 16-months follow-up was 90.1% and the rate of uncoverage was 9.9%.The result suggests that dual antiplatelet therapy might be continued for longer than 16 months after DES implantation.