应用光学相干断层成像评价药物洗脱支架术后再发急性冠脉综合征患者的原因

Pathology analysis of the recurrence ACS patients who had implanted DES by use of optical coherence tomography

目的探讨冠脉药物洗脱支架术后再发急性冠脉综合征(ACS)患者的可能原因。方法收集自2010年8月至2012年7月,本中心收治11例曾接受过冠脉支架介入治疗(PCI)治疗并植入药物涂层支架(DES),再发ACS的(男性9例,女性2例)患者,对该11例患者进行回顾性分析。应用光学相干断层显像(OCT)技术对罪犯血管检查,了解罪犯血管的病变情况。结果 DES植入术后再发ACS者不稳定性心绞痛(UA)多见,7例(7/11,63.6%),非ST段抬高心肌梗死(NSTEMI)1例(1/11,9%),ST段抬高心肌梗死(STEMI)3例(3/11,27.2%)。罪犯血管前降支(LAD)多见,8例(8/11,72.7%),右冠脉(RCA)3例(3/11,27.2%)。STEMI患者冠脉造影(CAG)诊断为支架内血栓形成(ST),OCT诊断为支架贴壁不良,同时存在支架内新生粥样硬化斑块(NAP)形成并破裂,NSTEMI患者CAG诊断为晚期支架内血栓形成(LST),OCT诊断为支架内NAP形成并破裂。UA患者CAG诊断为LST,OCT诊断为NAP、支架贴壁不良。7例(63.6%)患者存在吸烟史〔7例(100%)未能戒烟〕,8例(72.7%)患者LDL-C控制不达标。结论支架贴壁不良和支架内新生粥样硬化斑块破裂均可导致LST的发生。支架内新生动脉粥样硬化斑块是引起DES植入后再发ACS的另一主要病因。

Objective To analyze the pathology of the recurrence ACS patients who had implanted DES. Methods Data of llpatients who had underwent PCI were ACS reoccur from August 2010 to July 2012 were analyzed. Results The most patients were unstable angina（7/l1,63. 6% ） , one case for NSTEMI （1/11,9%） ,three cases for STEMI（3/ll, 27.2% ）. In the culprit vessel, LAD accouted for （8/11,72.7%）. The RCA was （3/11,27.2%）. The pathology of STEMI and NSTEMI from CAG was late thrombosis, but from OCT was stent struts malapposition and nouveau atheroscl erotic plaque respectively. The pathology of UA from CAG was restenosis, from OCT was nouveau atherosclerotic plaque. 7 patients were smokers. Eight of 11 patients whose level of LDL - C was higher. Conclusion Nouveau ather- osclerotic plaques within the stented segment is another cause in the recurrence of acute coronary syndrome patients who had implanted DES. Stent struts malapposition and Nouveau atherosclerotic plaques within the stented segment are the substrate for the late thrombosis after DES placement.