光学相干断层成像和血管内超声在冠状动脉介入手术中的应用

目的 应用光学相干断层成像(OCT)及血管内超声(IVUS)检测技术评价冠状动脉内粥样硬化斑块的稳定性,并指导支架置入,检测血管对置入支架后即刻和中远期的反应.方法 选择2008年2-7月间的27例患者,进行冠状动脉造影、OCT及IVUS检查,共检查了30支血管,其中8处为药物支架植入术后血管,并对19处病变进行了支架置入.结果 除外支架置入的8例(置入6个月～4年)外,其余22例病变行OCT及IVUS检查,发现稳定性斑块5例,不稳定斑块17例,其中OCT检出内膜小撕裂4例(IVUS未检出,P＞0.05),冠状动脉撕裂伴夹层病变5例(IVUS检出1例,P＞0.05),血栓形成5例(IVUS检出1例,P＞0.05),偏心斑块伴薄纤维帽12例(IVUS检出2例,P＜0.01).8例曾经进行支架治疗的患者,造影、OCT和IVUS发现2例再狭窄;OCT显示支架内膜覆盖良好,IVUS小能精确看到内膜;OCT检测出1例患者有支架后瘤样扩张.对17例不稳定性斑块及2例支架再狭窄病例行支架置入术,术后支架膨胀不良发生率26.0%,OCT及IVUS检出率相同;支架贴壁不良发生率63.2%,IVUS榆出率低于OCT(10.5%比63.2%,P＜0.01);支架近远端撕裂10.5%,IVUS均不能检出;内膜脱垂发生率52.6%,IVUS检出率低于OCT(10.5%比52.6%,P＜0.05).结论 OCT与IVUS相比,在不稳定性斑块检测准确度方面明显优于IVUS,更能精确指导冠状动脉支架置人.IVUS在操作简便性及反映斑块负荷方面要优于OCT.

Combined use of optical coherence tomography and intravascular ultrasound during percutaneous coronary intervention in patients with coronary artery disease

Objective To evaluate the value of combined optical coherence tomography (OCT) and intravascular ultrasound (IVUS) examinations in detecting coronary artery plaque during percutaneous transluminal coronary intervention (PCI).Methods CICT and IVUS examinations were performed on 30 diseased coronary vessels from 27 patients underwent PCI from Feb.2008 to Jul.2008.Results Seventeen vulnerable plaques (4 intima tearing which were not detected by IVUS),5 plaque rupture (1 out of 5 was detected by IVUS),5 thrombus lesions (1 out of 5 was found by IVUS),12 thin-cap lipid-rich lesions (2 detected by ivus) were detected by OCT in 22 lesions (without 8 lesions post DES stents).Analysis result of plaque burden by IVUS was superior to that obtained by OC T.In 8 DES stents (implanted for 6 months to 4 years).OCT detected 2 had severe restenosis,6 stents struts were completely covered with neointima without restenosis,1 stent had aneurysm-like dilatation.IVUS results were similar except for limitations on exactly detecting neointima post stenting.In 19 newly implanted stents.the incidence of stent underexpansion detected by OCT was 26.0% (same as that by IVUS).stent malappesition was 63.2% (10.5%by IVUS,P＜0.01),near stent tearing was 10.5% (not detected by IVUS),tissue prolapse between coronary stent struts was 52.6% (10.5% in IVUS,P＜0.05).Conclusions OCT imaging is superior to IVUS on detecting vulnerable plaques and change of structure around stents while IVUS is superior to OCT on estimating plaque burden in patients underwent PCI.