OCT对于DES术后晚期或晚晚期血栓治疗的指导作用

Guiding role of optical coherence tomography for the therapy of late or very late thrombosis after drug eluting stents implantation

目的 观察光学相干断层成像（OCT）技术对于药物洗脱支架（DES）术后发生晚期或晚晚期血栓治疗对策的指导作用.方法 选取2010年7月至2013年11月本院收治的行DES支架置入术后发生晚期或晚晚期支架内血栓患者22例,对患者行OCT检查,根据OCT结果采取进一步治疗措施.结果 DES术后晚期或晚晚期血栓的OCT表现为：支架内皮化不全6例、贴壁不良12例、支架内新生动脉粥样硬化斑块形成8例,支架内纤维过度增生较为少见2例,有些患者上述情况同时存在.治疗对策：单纯支架内皮化不全及支架贴壁不良者采取单纯球囊扩张术12例,新生动脉粥样硬化斑块形成或纤维过度增生者采取球囊扩张加支架置入术10例.结论 OCT可以准确了解DES术后晚期或晚晚期血栓的原因,提供更为合适的治疗方案.

Objective To observe the optical coherence tomography （OCT） imaging features in patients who had occurred late or very late thrombosis after drug eluting stents implantation,which can be benefit to further treatment.Methods Patients who had undergone drug eluting stents implantation in or out of our hospital with recurrence of acute coronary syndrome （ACS） in our hospital between January 2010 and November 2013 were enrolled,through OCT features to decide the next therapeutic regimen.Results In general,the OCT features of late or very late thrombosis after drug eluting atents implantation were incomplete stent endothelialization,stent malapposition,stent with the formation of nascent atherosclerotic plaque,however,stent fibrous hyperplasia was rare.Take balloons dilatation for patients with pure incomplete stent endothelialization and stent malapposition,patients with the formation of nascent atherosclerotic plaque and fibrous hyperplasia were treated by balloons dilatation and stents implantation.Conclusion OCT can be a better understanding of the precise causes of late or very late thrombosis after drug eluting stents implantation,and provide a more appropriate scheme.