光学相干断层显像评价冠状动脉支架边缘夹层的进展及优势

在冠状动脉支架植入过程中,支架两端的钢梁与紧邻血管壁之间可产生血管损伤即支架边缘夹层,是经皮冠状动脉介入治疗较常见的并发症,此并发症增加了发生支架内血栓、主要不良心血管事件的风险。随着冠状动脉内成像技术的不断发展,光学相干断层显像以其高分辨率在评价支架边缘夹层有其独特优势。本文对光学相干断层显像下支架边缘夹层的发生率、预测因素、诊断预后与处理作一综述。     

光学相干断层成像指导钙化病变介入治疗策略

冠状动脉钙化病变的存在,尤其是严重内膜钙化病变和钙化结节,明显增加了介入治疗的难度和风险。钙化病变普遍存在于目前的冠状动脉介入治疗中,中重度钙化病变约占30%,其中约5%为重度钙化病变。因此,准确地识别、评估钙化病变,选择恰当的技术,对严重钙化病变进行充分的预处理,对于提高手术成功率、减少手术相关并发症、改善患者近期/远期预后具有重要意义。目前常用的评估冠状动脉钙化的手段包括:冠状动脉CT血管造影、冠状动脉造影、血管内超声、光学相干断层成像等。血管内超声和光学相干断层成像是目前最常用的评估钙化病变的腔内影像学检查方法。与血管内超声相比,光学相干断层成像可评估钙化病变的厚度,能更准确地量化钙化病变的容积。因此,本文将综述光学相干断层成像在指导钙化病变介入治疗中的作用。     

光学相干断层成像在急性冠脉综合征介入治疗中的应用

光学相干断层成像在冠状动脉介入应用中有着高分辨率、高敏感性等特点,其对急性冠脉综合征患者冠状动脉介入的指导、术后的评估均有较大的指导意义。现对目前光学相干断层成像指导急性冠脉综合征介入治疗中的应用进行综述。     

血管内超声和光学相干断层成像在冠状动脉介入治疗中的应用对比

血管内超声（IVUS）和光学相干断层成像（optical coherence tomography,OCT）作为成熟的冠状动脉血管内成像技术,已成为冠状动脉造影的重要补充手段。IVUS的优势在于透射深度大,在管腔结构之外可获取血管壁结构;而OCT则空间分辨率高,与组织学结果高度相关。随着无需球囊阻断血流的频域光学相干断层成像（FD-OCT）的不断推广,OCT临床实用性增强。本文就最新研究进展中IVUS与FD-OCT的成像方式、对病变血管的评估效用及对介入治疗的指引作用进行对比,以探讨冠状动脉介入治疗影像学未来的发展方向。     

应用光学相干断层成像(OCT)评价冠状动脉内支架置入后的内膜覆盖

在冠状动脉介入治疗发展三十多年的今天,有许多新兴的技术来弥补冠状动脉造影的局限性,其中最具代表性的是血管内超声(IVUS)技术.IVUS不仅对判断冠状动脉病变程度、斑块是否稳定、管腔大小、是否需要介入治疗有重要参考价值,也是判断介入后支架是否贴壁良好、病变覆盖程度、是否有撕裂的主要手段,目前在全世界范围内广泛使用.冠状动脉内血管镜用来评价血管内膜对支架的覆盖程度、是否存在血栓.目前在日本的一些医院应用.自2001年开始国外首次报道光学相干断层成像(OCT)技术在人体冠状动脉内获得高清晰图像以来,OCT技术在冠心病介入领域中应用报道逐渐增多,目前备受国内外专家的高度关注.     

光学相干断层成像系统在经皮冠状动脉介入术后评估中的应用

光学相干断层成像系统（optical coherence tomography,OCT）是一种高分辨率的医学断层成像技术,可以提供冠状动脉的微观成像。OCT定义的薄纤维帽斑块是指纤维帽厚度不足65um的脂质斑块,常用作评估经皮冠状动脉介入治疗（percutaneous coronary intervention,PCI）术后并发症,     

光学相干断层成像评价经皮冠状动脉内支架术后即刻效果

冠状动脉内光学相干断层成像（OCT）是近几年发展起来的一种具有高分辨率和对比度的冠状动脉断层成像技术，其分辨率达10，比目前所有已知的冠状动脉成像检查方法高10倍以上，可以显示冠状动脉病变以及介入治疗后支架周围超微结构的改变。我中心自2005年8月开展OCT检查技术，初步研究结果显示该项检查安全有效，能够分辨斑块的细节特征，识别易损斑块，为介入治疗提供决策依据。本研究的目的是利用OCT分析冠状动脉支架置入术后支架周围超微结构特征。     

光学相干断层成像判断冠状动脉不稳定斑块

光学相干断层成像是近年出现的一项光学成像技术,其原理是基于光学干涉现象。该项技术与血管内超声相比具有更高的分辨率,本文根据光学相干断层成像在心血管疾病领域的研究进展,总结了该项技术对冠状动脉不稳定斑块方面的研究现状。     

光学相干断层显像指导治疗支架内新生动脉粥样硬化致再狭窄1例

正冠脉介入术后支架内再狭窄(ISR)的发生率可达10%～15%,是困扰介入医师的梦魇,随着冠心病患者的不断增加及接受冠脉介入治疗数量的逐年增长,老年患者ISR的例数将呈递增趋势。光学相干断层显像(OCT)可清晰显示在体冠脉管腔内的细微结构,提供近似组织病理学的影像学观察。OCT能够评估ISR的解剖及形态特征,探讨ISR的发生机制、为介入治疗策略提供依据。本文报告1例光学相干断层显像指导治疗支架内新生动脉粥样硬化致再狭窄病例。     

光学相干断层成像判断冠状动脉不稳定斑块

光学相干断层成像是近年出现的一项光学成像技术,其原理是基于光学干涉现象.该项技术与血管内超声相比具有更高的分辨率,本文根据光学相干断层成像在心血管疾病领域的研究进展,总结了该项技术对冠状动脉不稳定斑块方面的研究现状.     

Sirolimus‐eluting stent fracture detection by three‐dimensional optical coherence tomography

Stent fracture has emerged as a complication of drug‐eluting stent and is now recognized as contributing to in‐stent restenosis and possibly stent thrombosis. Although optical coherence tomography (OCT) can detect stent fractures in the absence of circumference struts, it is challenging to visualize stent fractures with only cross‐sectional OCT images. We describe two cases of restenosis with stent fracture detected by a novel three‐dimensional OCT image reconstruction technique. This technique allows identification of a single stent fracture even in the absence of angiographic signs. © 2011 Wiley Periodicals, Inc.     

Membranous diaphragm formation after simultaneous kissing stenting with sirolimus‐eluting stents for the left main bifurcation

Two patients who underwent simultaneous kissing stenting with sirolimus‐eluting stents in the left main coronary artery were investigated with optical coherence tomography (OCT) at just more than 1 year postoperatively. In both cases, follow‐up angiogram indicated complete coverage of the new metal carina with a membranous diaphragm, yet OCT showed varying tissue‐coverage patterns transitioning from stent inflow to stent outflow. These patterns included single‐strut coverage, bridge‐like membrane formation between more than 1 strut, and end‐to‐end coverage of the carina; no uncovered stent struts were detected. OCT also demonstrated mixed patterns of tissue characteristics on the metal carina, ranging from poor endothelialization to modest neointima formation. These varying tissue characteristics suggest that the process of tissue coverage in the metal carina is different from that occurring on the vessel wall; this may indicate delayed healing in the carina. © 2013 Wiley Periodicals, Inc.     

Early healing after treatment of coronary lesions by thin strut everolimus,or thicker strut biolimus eluting bioabsorbable polymer stents: The SORT-OUT VIII OCT study

Aims

Early healing after drug-eluting stent (DES) implantation may reduce the risk of stent thrombosis. The aim of this study was to compare patterns of early healing after implantation of the thin strut everolimus-eluting Synergy DES (Boston Scientific) or the biolimus-eluting Biomatix Neoflex DES (Biosensors).

Methods and Results

A total of 160 patients with the chronic or acute coronary syndrome were randomized 1:1 to Synergy or Biomatrix DES. Optical coherence tomography (OCT) was performed at baseline and at either 1- or 3-month follow-up. The primary endpoint was a coronary stent healing index (CSHI), a weighted index of strut coverage, neointimal hyperplasia, malapposition, and extrastent lumen. A total of 133 cases had OCT follow-up and 119 qualified for matched OCT analysis. The median CSHI score did neither differ significantly between the groups at 1 month: Synergy 8.0 (interquartile range [IQR]: 3.0; 14.0) versus Biomatrix 8.5 (IQR: 4.0; 15.0) (p = 0.47) nor at 3 months: Synergy 6.5 (IQR: 2.0; 13.0) versus Biomatrix 6.0 (IQR: 4.0; 11.0) (p = 0.83). Strut coverage was 84.6% (IQR: 72.0; 97.9) for Synergy versus 77.6% (IQR: 70.1; 90.3) for Biomatrix (p = 0.15) at 1 month and 90.3% (IQR 79.0; 98.8) (Synergy) versus 83.9% (IQR: 77.5; 92.6) (Biomatrix) (p = 0.068) at 3 months. Pooled 1 - and 3-month coverage was 88.6% (IQR: 74.4; 98.4) for Synergy compared with 80.7% (IQR: 73.2; 90.8) for Biomatrix (p = 0.02).

Conclusions

The early healing response after treatment with the Synergy or Biomatrix DES did not differ significantly as determined by a healing index. The Synergy DES showed overall better early stent strut coverage.     

Impact of an optical coherence tomography guided approach in acute coronary syndromes: A propensity matched analysis from the international FORMIDABLE‐CARDIOGROUP IV and USZ registry

Aim. To determine the potential clinical impact of OCT (Optical Coherence Tomography) during primary percutaneous coronary intervention in patients presenting with ACS (Acute Coronary Syndrome). Methods and Results. FORMIDABLE is a multicentre retrospective registry enrolling all patients presenting with ACS and treated with an OCT‐guided approach, while the USZ registry enrolled patients treated with a standard angiography guided approach. Multivariate adjustment was performed via a propensity score matching. The number stents useds was the primary outcome, while the incidence of MACE (a composite of death, myocardial infarction, target vessel revascularization, and stent thrombosis) was the secondary endpoint. A total of 285 patients OCT‐guided and 1,547 angiography guided patients were enrolled, resulting in 270 for each cohort after propensity score with matching. Two stents were used in 12% versus 34%; 3 stents in 8% versus 38% of the patients (P < 0.001). After a follow up of 700 days (450–890), there was no difference in myocardial infarction (6% vs. 6%, P = 0.86), while MACE (11% vs. 16%, P = 0.06), target vessel revascularization (2% vs. 4%, P = 0.15) and stent thrombosis rates (0% vs. 2.7%, P = 0.26) were numerically lower for the OCT‐guided cohort but none of these endpoints did reach statistical significance. Conclusions. An OCT‐guided approach reduced the number of stents used, number of patients treated with more than one stent, while there was no statistically significant difference in clinical endpoints while most of them were numerically lower, including stent thrombosis rates. © 2016 Wiley Periodicals, Inc.     

Difference of neointimal growth patterns in bifurcation lesions among four kinds of drug‐eluting stents

Aim: Neointimal proliferation of bifurcation lesions after implantation of drug‐eluting stents (DES) has not been well evaluated. Thus, we compared neointimal proliferation of bifurcation lesions among four DES using optical coherence tomography (OCT). Methods: 8‐month follow‐up OCT was performed in 68 bifurcation lesions treated by 15 sirolimus‐eluting stents (SES) and 17 paclitaxel‐eluting stents (PES) as first‐generation DES, and by 17 zotarolimus‐eluting stents (ZES) and 19 everolimus‐eluting stents (EES) as second‐generation DES. Cross‐sectional images of the bifurcation lesion using OCT were analyzed every 450 µm. All images were divided into three areas: inner wall of the bifurcation (IB), outer wall of the bifurcation (OB), and ostium of the side branch (SB). We compared the incidence of uncovered struts (IUS) among three areas and the averaged neointimal thickness (NIH) between IB and OB in each stent and also compared these OCT parameters among all DES. Results: There were no significant differences of IUS between IB and OB in second‐generation DES, while in first‐generation DES, IUS of IB and OB showed significant differences. The IUS of SES in both areas was significantly higher than in the other DES (all P < 0.001). PES had a significantly higher IUS in SB than the others (all P < 0.001). NIH of OB was significantly higher than that of IB in PES, ZES, and EES, but in SES the NIH was similar in the two areas. Conclusions: OCT revealed different neointimal growth patterns among SES, PES, ZES, and EES in bifurcation lesions. © 2014 Wiley Periodicals, Inc.     

Optical coherence tomography-derived predictors of stent expansion in calcified lesions

Background

Severe coronary artery calcification is associated with stent underexpansion and subsequent stent failure.

Aims

We aimed to identify optical coherence tomography (OCT)-derived predictors of absolute (minimal stent area [MSA]) and relative stent expansion in calcified lesions.

Methods

This retrospective cohort study included patients who underwent percutaneous coronary intervention (PCI) with OCT assessment before and after stent implantation between May 2008 and April 2022. Pre-PCI OCT was used to assess calcium burden and post-PCI OCT was used to assess absolute and relative stent expansion.

Results

A total of 361 lesions in 336 patients were analyzed. Target lesion calcification (defined as OCT-detected maximum calcium angle ≥ 30°) was present in 242 (67.0%) lesions. Following PCI, median MSA was 5.37 mm² in calcified lesions and 6.24 mm² in noncalcified lesions (p < 0.001). Median stent expansion was 78% in calcified lesions and 83% in noncalcified lesions (p = 0.325). In the subset of calcified lesions, average stent diameter, preprocedural minimal lumen area, and total calcium length were independent predictors of MSA in multivariable analysis (mean difference 2.69 mm²/mm², 0.52 mm²/mm, and −0.28 mm²/5 mm, respectively, all p < 0.001). Total stent length was the only independent predictor of relative stent expansion (mean difference −0.465% per mm, p < 0.001). Calcium angle, thickness, and the presence of nodular calcification were not significantly associated with MSA or stent expansion in multivariable analyses.

Conclusion

Calcium length appeared to be the most important OCT-derived predictor of MSA, whereas stent expansion was mainly determined by total stent length.     

光学相干断层成像比较猪冠状动脉西罗莫司洗脱支架与佐他莫司洗脱支架置入后早期新生内膜覆盖情况

目的应用光学相干断层成像(OCT)比较西罗莫司洗脱支架(SES)与佐他莫司洗脱支架(ZES)置入后1月内新生内膜覆盖情况。方法 18只中华小型猪平均分为3组,每只猪分别在前降支和右冠状动脉随机置入SES和ZES支架各一枚,3组实验动物分别在第7天、14天、28天进行OCT检查,测量新生内膜厚度、支架内面积、管腔内面积、新生内膜面积、面积狭窄百分比和新生内膜覆盖率,比较ZES与SES置入后1月内新生内膜覆盖情况。结果 OCT测量结果显示,支架置入7天和14天时,ZES与SES两种支架丝表面新生内膜厚度和新生内膜覆盖率均存在显著统计学差异(P<0.001)。同样支架术后28天时ZES与SES支架丝表面新生内膜厚度存在显著统计学差异(244.3±282.3μmvs136.3±91.1μm,P<0.001),新生内膜覆盖率存在显著差异(94.88%±2.93%vs90.96%±4.35%,P=0.008)。结论在支架置入后1个月内,ZES与SES比较新生内膜增生更显著,支架丝表面新生内膜覆盖率更高。     

Immediate results of bifurcational stenting assessed with optical coherence tomography

Background : A tubular stent may adapt with difficulty to coronary bifurcation lesions (CBLs). Methods : Time domain or frequency domain (FD) optical coherence tomography (OCT) was performed to assess strut apposition immediately after stent implantation across four segments inside the bifurcation, in a consecutive series of patients. OCT pullbacks were performed in the main vessel (MV). Results : A total of 13,142 struts in 45 CBL in 41 patients were assessed. Strut malapposition was significantly more frequent in the half bifurcation facing the side‐branch (SB) ostium (42.9%) than in the proximal segment of the bifurcation 11.8%, half bifurcation opposite the SB 6.7%, or the distal segment 5.7% (all P < 0.0001). Lesions (n = 15) treated with stenting of both MV and SB had a total higher rate of malapposition than those (n = 30) treated with stenting of the MV only (17.6% vs. 9.5%; P = 0.0014). In latter group, lesions treated with FD‐OCT‐guided stent implantation (n = 13) presented a lower rate of malapposition than those treated with conventional angiographic‐guided stent implantation (n = 17) (7.1% vs. 17.5%; P = 0.005). Conclusions : In CBL, strut malapposition is particularly high at the SB ostium. However, a strategy of stenting MV only with adjunctive FD‐OCT guidance is associated with lower rates of malapposition. © 2012 Wiley Periodicals, Inc.     

Erosion/malapposition of a sirolimus eluting stent – Optical coherence tomography image – A case report

The presence of erosion/malapposition of a Sirolimus eluting stent was clearly visualized using Optical Coherence Tomography (OCT) imaging. The presence of erosion/malapposition and the absence of neointimal hyperplasia after 10 months of sirolimus eluting stent could constitute a potential thrombogenic substrate for late stent thrombosis.