光学相干断层成像评价植入不同药物洗脱支架后的血管愈合情况

Evaluation by optical coherence tomography of vascular healing after drug-eluting stents implantation in acute myocardial infarction

目的应用光学相干断层成像(OCT)比较急性心肌梗死(AMI)患者植入不同药物洗脱支架(DES)后的新生内膜覆盖和支架贴壁情况以评估血管愈合。方法 49例AMI患者植入不同DES后9个月时进行OCT检查。其中20个雷帕霉素药物洗脱支架(SES,Cypher),12个紫杉醇药物洗脱支架(PES,Taxus)和17个雷帕霉素衍生物药物洗脱支架(ZES,Endeavor)。每隔1mm评估OCT横断面影像每个支架柱的新生内膜覆盖和贴壁情况,同时观察每个支架内的血栓发生情况。结果总计对12378个支架柱进行了分析。SES的新生内膜增生最少,新生内膜厚度:SES(77±60)μm、PES(153±82)μm、ZES(265±130)μm,且新生内膜增生面积百分比最低,SES(10±8)%、PES(19±8)%、ZES(28±9)%,但SES和PES有更多未被新生内膜覆盖的支架柱,SES(15.1±16)%、PES(7.1±10)%、ZES(0.6±1.5)%,且贴壁不良支架柱的发生率也高于ZES,SES(3.8±7.2)%、PES(2.1±4.4)%、ZES(0±0)%,而有完全新生内膜覆盖的支架比例以ZES为高,SES5%、PES33.3%、ZES82.4%。血栓的发生率SES和PES高于ZES,SES34%、PES33%、ZES6%。结论 AMI患者植入不同类型DES后,其支架的新生内膜覆盖程度和贴壁不良的发生率是显著不同的,因此DES的类型可能影响了AMI血栓性病变的血管愈合过程。

Objective To compare neointimal coverage and stent malapposition after DESs implantation in patients with acute myocardial infarction using optical coherence tomography（OCT）.Methods OCT was analyzed at 9-month after DESs implantation in 49 AMI patients [20 sirolimus eluting stent（SES,Cypher）,12 paclitaxel eluting stent（PES,Taxus）and 17 zotarolimus eluting stent（ZES,Endeavor）].Neointimal thickness and strut apposition were measured at each stent strut and every 1 mm corss section.Presence of thrombus was observed in each stent.Results In total,12378 stent struts were analyzed.SES had the least neointimal thickness（SES 77±60 μm vs PES 153±82 μm vs ZES 265±130 μm,P0.01）and percentage of neointimal hyperplasia area（SES 10±8 vs PES 19±8 vs ZES 28±9,P0.01）,while percentage of uncovered struts were higher in SES and PES than in ZES（SES 15.1±16 vs PES 7.1±10 vs ZES 0.6±1.5,P0.01）.Malapposed struts were also more in SES and PES than in ZES [SES（3.8 ± 7.2）% vs PES（2.1 ± 4.4）% vs ZES（0±0）%,P0.01].Higher prevalence of throumbus was found in SES and PES than in ZES（SES 34% vs PES 33% vs ZES 6%,P0.05）.Conclusions The rate of stent strut coverage and malapposition were significantly different among the DES types in acute myocardial infarction,therefore the type of DES might affect the vascular healing patterns in thrombotic lesions of acute myocardial infarction.