冠状动脉斑块旋磨术治疗严重钙化病变术中引起血小板聚集的光学相干断层成像证据

Platelet aggregation on optical coherence tomography after rotational atherectomy of severely coronary calcified lesions

目的采用光学相干断层成像(OCT)证实冠状动脉斑块旋磨术对血小板激活的影响。方法连续纳入2019年7月至2019年12月于北京大学人民医院行OCT指导行冠状动脉斑块旋磨治疗的患者20例,分别在旋磨前、后行OCT检查。结果20例患者中14例旋磨头直径为1.5 mm。20例患者平均旋磨速度为(15.2±0.4)×10^4 r/min,旋磨次数为(5.3±2.1)次,平均总旋磨时间为(49.5±8.1)s。其中有1例在旋磨后出现无复流现象。所有患者旋磨后行OCT检查,靶病变均出现血小板聚集现象(白色血栓),平均出现(7.2±4.4)个白血栓,尺寸为(0.5±0.3)mm。Pearson相关分析显示,血小板聚集的负荷大小与旋磨头直径(r=0.575,P=0.040)和总旋磨时间(r=0.599,P=0.031)相关。结论采用OCT证实,冠状动脉斑块旋磨术中可以引起血小板聚集,血小板聚集负荷与旋磨头大小和总旋磨时间相关。

Objective To investigate the effect of rotational atherectomy(RA)on platelet aggregation based on optical coherence tomography(OCT).Methods A total of 20 consecutive patients with severe coronary calcified lesions by OCT imaging performed before,after RA and after stent implantation were analyzed.Results The burr size was 1.5 mm,the mean rotation speed was(15.2±0.4)×10^4 r/min,the mean number of rotations per patient was(5.3±2.1)times and mean ablation time per RA was(49.5±8.1)seconds.No reflow was occurred only in 1 case after RA.All the target vessels had platelet aggregation on OCT after RA.The average number of white thrombus per lesion after RA was(7.2±4.4),and the average length of every white thrombus was(0.5±0.3)mm.In Pearson Correlation Analysis,platelet aggregation load was related with burr size(r=0.575,P=0.040)and total rotation times(r=0.599,P=0.031).Conclusions Platelet aggregation during RA is proved by OCT in vivo.The platelet aggregation load is related to burr size and total ablation times.