血管造影配准光学相干断层成像引导经皮冠状动脉介入治疗急性冠脉综合征

Angiographic co-registered optical coherence tomography for guiding percutaneous coronary intervention of acute coronary syndrome

目的观察血管造影配准光学相干断层成像(ACR-OCT)引导经皮冠状动脉介入(PCI)治疗急性冠脉综合征(ACS)的安全性。方法纳入66例接受PCI的ACS患者;根据引导PCI方式分为数字减影血管造影(DSA)组、OCT组及ACR-OCT组,每组22例。对支架外地理丢失、支架边缘夹层、支架贴壁不良、支架膨胀不良发生率及其他指标进行组间两两比较,评估ACR-OCT组的治疗安全性。结果ACR-OCT组未见严重支架边缘夹层。两两比较,ACR-OCT组支架外地理丢失发生率明显低于DSA组和OCT组(P均<0.05),OCT组和ACR-OCT组支架膨胀不良及支架贴壁不良发生率均明显低于DSA组(P均<0.05);组间治疗时间、对比剂用量及住院时长等其他指标差异均无统计学意义(P均>0.05)。结论ACR-OCT引导PCI治疗ACS的安全性优于单纯OCT或DSA,且不增加治疗时间、对比剂用量及住院时长。

Objective To observe the safety of angiographic co-registered optical coherence tomography(ACR-OCT)for guiding percutaneous coronary intervention of acute coronary syndrome(ACS).Methods Totally 66 ACS patients who underwent PCI were enrolled and divided into digital subtraction angiography(DSA)group,OCT group or ACR-OCT group according to the guiding method of PCI(each n=22).The incidence of longitudinal geographic mismatch,edge dissection,stent malapposition,under-expansion and other indexes were compared between each 2 groups.The therapeutic safety of ACR-OCT group was evaluated.Results No severe stent edge dissection was found in ACR-OCT group.Pairwise comparison showed that the incidence of longitudinal geographic mismatch in ACR-OCT group was significantly lower than that in DSA group and OCT group(both P<0.05),stent malapposition and under-expansion in ACR-OCT group and OCT group were both significantly lower than those in DSA group(both P<0.05).No significant difference of other indexes,such as operation time,contrast agent dosage nor hospitalization time was found between each 2 groups(all P>0.05).Conclusion The safety of ACR-OCT for guiding PCI was better than that of OCT and DSA for treating ACS,and the operation time,contrast agent dosage and hospitalization time did not increased under ACR-OCT guidance.