光学相干断层成像在经皮冠状动脉介入治疗前后的应用

Application of Optical Coherence Tomography in Patients Before and After Percutaneous Coronary Intervention

目的：探讨光学相干断层成像（OCT）在经皮冠状动脉介入治疗（PCI）前后应用的指导作用。方法：入选40例于我院行冠状动脉造影患者,根据罪犯血管狭窄程度分为两组：A组（狭窄程度≤75%,n=20）冠状动脉造影后行OCT检查,观察有无富含脂质斑块、薄帽纤维粥样斑块、斑块破裂、血栓,并测定病变狭窄程度;如需置入支架,则在术后即刻复查OCT,观察有无支架杆贴壁不良、血管夹层、组织脱垂等。B组（狭窄程度〉75%,n=20）仅在支架置入术后即刻行OCT检查。结果：A组20例患者的20支罪犯血管中,15支（75%）病变狭窄程度〉70%,其中3支为支架内再狭窄,6支血管发现斑块破裂,3支血管发现血栓形成,共发现富含脂质斑块22处、薄帽纤维粥样斑块9处（平均纤维帽厚度0.06 mm）;共置入支架19枚,术后即刻行OCT检查,13枚支架（68.4%）可见不同程度的组织脱垂,平均最大组织脱垂面积为0.16±0.05（0.09~0.21）mm2,4枚支架（21.1%）中8个支架杆贴壁不良。B组20例患者的20支罪犯血管共置入34枚药物洗脱支架,术后即刻行OCT检查,有28枚支架（82.4%）存在不同程度的组织脱垂,平均最大组织脱垂面积为0.40±0.31（0.06~1.02）mm2。有9枚支架（26.5%）共20个支架杆贴壁不良。所有患者随访6个月以上,未发生严重心脏缺血事件。结论：OCT技术在支架术前可清晰显示冠状动脉结构、辨别不同斑块、斑块破裂及血栓,精确测量管腔狭窄程度。在支架术后可清晰显示血管夹层,组织脱垂及支架杆贴壁情况,可以指导及评价介入治疗。

Objective：To evaluate the role of optical coherence tomography（OCT）in patients before and after percutaneous coronary intervention（PCI）.Methods：We summarized 40 patients who underwent PCI,they were divided into two groups according to coronary angiography（CAG）confirmed lesions.Group A,coronary stenosis ≤75%,n=20,the patients had OCT to examine the lesion morphologies pre-and post-stent implantation;and Group B,coronary stenosis75%,n=20,the patients had OCT post-stent implantation.The characteristics of atherosclerotic plaques,severity of stenosis,dissection and tissue prolapse were evaluated by OCT.All patients were followed-up for more than 6 months.Results：In group A,OCT image was successfully obtained in 20 culprit coronary arteries in 15 patients（75%）.They had lesions with percent area stenosis70%,which included 3 in-stent re-stenosis,6 plaque ruptures,3 thrombus,22 lipid-rich plaques,9 thin-capped fibroatheromas（TCFAs）;19 drug eluting stents（DES）were implanted.OCT images showed different tissue prolapse in 13 stents,the mean maximal area of tissue prolapse was（0.16±0.05）mm2,8 struts of 4 stents were mal-appositioned.In group B,OCT images were successfully obtained in 20 culprit vessels after PCI,34 DES were implanted,OCT image indicated that different tissue prolapse in 28 stents,the mean maximal area of tissue prolapse was（0.40±0.31）mm2,20 struts of 9 stents were mal-appositioned.During the follow-up period of time,no patient suffered from severe ischemic cardiac events.Conclusion：OCT image can clearly present the coronary microstructure and distinguish different plaque,plaque rupture and thrombus before PCI,and indicate the stent mal-apposition,dissection and tissue prolapse after PCI.It is,therefore,promising for guiding PCI procedure.