头颈部血管内支架植入术后光学相干层析成像初步观察

Preliminary observation of the changes of organizational structures with optical coherence tomography after endovascular stent implantation in head and neck

目的采用频域光学相干层析成像(FD-OCT)技术观察头颈部血管内支架植入术后周围组织结构变化。方法对9例接受头颈部血管内支架植入术治疗3个月后头颈部血管病变患者作全脑DSA造影及病变血管内FD-OCT检查。9例患者12个血管病变处共植入支架13枚,其中颈总动脉4枚,颈内动脉5枚,椎动脉3枚,左锁骨下动脉1枚。FD-OCT观察支架有无断裂及贴壁不良,支架内斑块或血栓形成、组织脱垂,血管内膜撕裂形成夹层或内膜增生至再狭窄等。结果 8例患者成功实施FD-OCT检查,1例失败。11支病变血管12枚支架成功获取清晰FD-OCT图像,观察结果显示,12枚支架中有1枚支架部分支撑杆未能完全封闭动脉壁上瘤口;21个支撑杆贴壁不良;2枚支架内有斑块及血栓形成;6枚支架内有不同程度血管内膜增生,其中1枚支架内严重内膜增生至支架内狭窄作再次支架植入术;3枚支架内有4个不同程度组织脱垂;未发现血管内膜撕裂形成夹层。结论 FD-OCT可清晰显示头颈部血管病变支架植入术后支架内斑块或血栓形成、组织脱垂、血管内膜撕裂或增生及支架贴壁情况,其临床意义有待进一步研究。

Objective To observe the changes of the organizational structures surrounding the blood vessels after endovascular stent implantation in head and neck by using frequency domain optical coherence tomography （FD-OCT）. Methods Both digital subtraction angiography （DSA） of whole brain and FD-OCT of diseased vessels were performed in 9 patients with head and neck vascular diseases within three months after they received endovascular stent implantation treatment. In the 9 patients, a total of 12 vascular lesions were detected and a total of 13 stents were implanted in the involved arteries, including common carotid artery （CCA, n=4）, internal carotid artery （ICA, n=5）, vertebral artery （VA, n=3）, and left subclavian artery （SCA, n=l）. FD-OCT imaging was used to determine whether there were any abnormal conditions, such as the fracture and poor adherence of the stents, plaque or thrombosis within the stents, tissue prolapse, vascular dissection due to intimal tear, restenosis due to intimal hyperplasia, etc. Results OCT examination was successfully performed in 8 patients, and it failed in one patient. Clear FD-OCT images of 12 stents within 11 diseased vessels were obtained, which showed that some struts of one stent failed to completely seal the aneurysmal orifice on the arterial wall. Poor adherence of the struts was seen in 21 stents. Plaque or thrombosis within the stent was found in 2 stents. Intimal hyperplasia in different degrees was observed in 6 stents, and in one stent of them restenosis due to severe intimal hyperplasia occurred and stent implantation had to be carried out again. Four tissue prolapses in different degrees were seen in 3 stents. No vasculardissection due to intimal tear was observed. Conclusion FD- OCT can dearly display the plaque or thrombosis within the stents, the tissue prolapse, the intimal tear or hyperplasia, and the stent adherence. However, the clinical significance of FD- OCT examination needs to be further clarified.