采用光学相干断层成像技术评价国产雷帕霉素洗脱支架术内膜覆盖情况

Objective:Confirming complete neointimal coverage after implantation of drug-eluting stent(DES)is clinically important because incomplete stent coverage is maybe responsible for late thrombosis and sudden cardiac death.Optical coherence tomography(OCT)is a high-resolution(≈10 μm)imaging technique capable of detecting a thin layer of neointimal hyperplasia(NIH)inside DES.Helios stent system(KinheIy Bio-tech Co(Shenzhen).Ltd)is a new generation of sirolimus eluting stents.Methods:Motorized optical coherence tomographic pullback was performed at 9-month follow-up to examine consecutive Helios stent mplantations in 10 patients.NIH thickness inside each strut and NIH area percentage inside each cross-section were measured.Results:In total,2063 struts in 296 mm stented segments were analyzed.Overall,NIH thickness were(95.7±66.62)μm,rates of exposed struts was 60.2% and the average NIH area percentage was 5.0618% ± 5.6625%.Conclusion:Our study suggests that dual antiplatelet therapy after Helios stent implantation must be continued at least 9months after DES implantation.

高密度脂蛋白胆固醇水平对药物洗脱支架植入后早期血管愈合的影响

目的:在动脉粥样硬化性心血管疾病(ASCVD)患者植入药物洗脱支架(DES)后第1和第2个月,使用光学相干断层扫描(OCT)研究基线高密度脂蛋白胆固醇(HDL-C)水平对早期血管愈合的影响。方法:此回顾性研究建立于PIONEER-ⅡOCT临床试验(ClinicalTrials.gov Identifier:NCT02747329)基础上。不论DES的品牌,根据基线HDL-C水平对每个队列中存在高出血风险的患者进行分组(高HDL-C水平≥1.0 mmol/L,低HDL-C水平<1.0 mmol/L)。队列1中的患者在经皮冠状动脉介入治疗(PCI)后1个月行OCT成像(高HDL-C组:16例患者,17个血管病变;低HDL-C组:15例患者,18个血管病变);队列2中的患者在PCI术后2个月行OCT成像(高HDL-C组:25例患者,28个血管病变;低HDL-C组:17例患者,19个血管病变)。结果:在第1个月随访时,高HDL-C组的支架小梁血管内膜覆盖率明显高于低HDL-C组(P=0.021),愈合评分显著优于低HDL-C组(P=0.019);在第2个月随访时,高HDL-C组与低HDL-C组之间支架小梁血管内膜覆盖率和愈合评分均差异无统计学意义(P=0.42、0.46)。结论:在DES植入后1个月,基线HDL-C水平≥1.0 mmol/L的患者比基线HDL-C水平<1.0 mmol/L的患者有更好的支架小梁血管内膜覆盖;但是在DES植入后第2个月的随访患者中,支架小梁血管内膜覆盖的差异不显著。这表明在DES植入后靶血管愈合的过程中,较高的HDL-C水平很可能促进了早期(术后1个月)新生内膜覆盖。