冠状动脉慢性完全闭塞病变介入治疗后的OCT研究

Different Vessel Response between Chronic Total Occlusions(CTO) and non-CTO Lesion after Sirolimus-eluting Stent Implantation A Serial Optical Coherence Tomography Study

目的:通过光学相干断层成像技术(Optical Coherence Tomography,OCT)观察冠脉慢性完全闭塞病变(Coronary Total Occlusion,CTO)与非闭塞性病变在植入药物洗脱支架(Sirolimus-eluting Stents,SES)后的血管反应(新生内膜覆盖情况和支架小梁贴壁情况)。方法:共入选64位患者,分成CTO组、富含脂质斑块(Lipid-rich Plaque,LRP)组与非富含脂质斑块(non-LRP)组。分别于术前、术后即刻、6月随访时行OCT检查。结果:术后即刻,CTO组与LRP组支架贴壁不良的发生率要高于non-LRP组(3.03%%,2.58%%vs.0.64%,P=0.0219);组织脱垂、支架内血栓的发生率从高到低依次为LRP组、CTO组、non-LRP组(14.99%vs.11.00%vs.6.41%,P<0.001;3.81%vs.2.39%vs.1.07%,P=0.0119)。6月随访时,三组比较(CTO组vs.LRP组vs.non-LRP组),CTO组贴壁不良发生率(5.0%vs.1.04%vs.0.4%,P=0.002)、伴有支架小梁裸露的截面数(23.4%vs.8.2%vs.6.6%,P<0.001)以及伴有支架小梁突出的截面数(30.8%vs.9.6%vs.9.6%,P<0.001)较高。结论:植入SES后不同的血管反应和冠脉原始病变特征有关。CTO病变与LRP病变在植入支架即刻更易于发生贴壁不良、组织脱垂和支架内血栓。6个月随访时,CTO病变的血管内皮化和愈合延迟,且贴壁不良的发生率较高。

Objective： To investigate the neointimal coverage and malapposition of sirolimus-eluting stentt in treatment of chronic total occlusions （CTOs） and non-CTO lesions （including lipid-rich plaque and non-lipid-rich plaque） by optical coherence tomography. Methods： We enrolled 64 patients （CTO： n=29 stents/21 patients, lipid-rich plaque： n=33 stents/26 patients, and non-lipid-rich plaque： n=21 stents/17 patients） with 68 target vessels and examined lesion characteristics by using OCT at pre- and post-sirolimus-eluting stents （SES） implantation, and 6 months＇ follow-up. Lipid rich plaque was defined as the plaque with lipid content in -〉 2 quadrants. Non-lipid-rich plaque consists of fibrous, fibrocalcific plaque, and lipid plaque with less than 2 quadrants lipid content. Results： The incidence of incomplete stent apposition was higher in CTO and lipid rich plaque group compared with those with non-lipid rich plaque （3.03 %, 2.58 % vs.0.64 %, P=0.0219）. The tissue protrusion（14.99 % vs. 11.00 % vs. 6.41%, P〈0.001） and intra-stent thrombus（3.81% vs. 2.39 % vs. 1.07 %, P=0.0119） after percutaneous coronary intervention were observed most frequently in lipid-rich plaque group than CTO group and non-lipid rich plaque group. At 6 months＇ follow-up, the incidence of malapposition （5.0 % vs. 1.04 % and 0.4 %, P= 0.002）, the cross section with uncovered struts （23.4 % vs. 8.2 % and 6.6 %, P〈0.001）, and protrusion （30.8 % vs.9.6 % and 9.6 %, P〈0. 001） was significantly greater in patients with CTO than those with lipid rich plaque and non-lipid rich plaque. Although the incidence of in-stent thrombus was non-significantly higher in CTO than LRP and non-LRP （9.4 % vs.3.1% vs.0, P=0.26）, there was no adverse event in these patients with CTO. Conclusions： Initial lesion morphology is contributable to coronary artery response to DES after stent implantation. CTOs and lipid rich plaque is associated with higher incidence of malapposition, tissue protrusion, and mural thrombus after stenting. At 6 months follow up, the vessels with CTO lesion was characterized by delayed healing and higher incidence of malapposition.