光学相干断层成像在急性冠脉综合征患者临界病变中的初步应用

目的：评价光学相干断层成像（OCT）在急性冠脉综合征（ACS）患者冠脉临界病变的应用。方法：选择8例ACS患者，其中急性心肌梗死1例，不稳定心绞痛7例，先行冠脉造影，对冠状动脉造影显示狭窄程度介于50％和70％之间的病变（即临界病变）行冠脉内OCT检查，测量冠脉病变狭窄程度，评价靶病变斑块的脂核大小、纤维帽的厚度、是否存在斑块破裂、是否伴有血栓形成等。根据OCT检查结果对考虑不稳定易损斑块行冠脉内支架置入（PCI）治疗，稳定斑块选择药物保守治疗。结果：8例患者共14处病变，OCT检查显示14处病变的病变狭窄率均超过50％，7处斑块脂核较大、纤维帽厚度小于70μm，2处有斑块破溃，包括1处有局部血栓形成，以上判定为不稳定易损斑块，行冠状动脉内支架置入术。其余4处病变脂核较小，纤维帽厚度大于70μm，为厚纤维帽稳定斑块，选择药物保守治疗。结论：OCT能发现ACS患者冠脉造影显示为临界病变靶血管内的易损斑块，为高危ACS患者冠脉临界病变制定冠脉介入治疗策略的依据。

Initially application of optical coherence tomography in patients with borderline acute coronary syndrom

Objective:To evaluate application of optical coherence tomography(OCT) in interventional diagnosis and treatment of borderline acute coronary syndrom(ACS).Methods:8 patients were selected,including 1 case with acute myocardial infarction,7 cases with unstable angina.The cases of ACS with 50%~70% stenotic lesions in angiography were examined with intravascular OCT.The stenosis percentage,size of lipid core,thickness of fibrous cap were measured.The plaque rupture and thrombosis were observed.Therapeutic strategies were made according to OCT outcomes,patients with unstable vulnerable plagues underwent percutaneous coronary intervention(PCI),the other underwent drug therapy.Results:In all 14 lesions stenosis exceed 50%,large lipid core and fibrous cap thinner than 70 μm were found in 7 lesions,plaque ruptures were noted in 3 of the lesions including 1 thrombosis.So PCI were performed in these lesions.The other 4 lesions with small lipid cores and thick fibrous caps were defined stability thickness fibrous cap plaques.Thus PCI was not performed.Conclusion: OCT can find small thin fibrous cap of vulnerable plaques endovascular in patients with borderline acute coronary syndrom,which is the basis of coronary interention strategy formulation for high risk patients with critical acute coronary syndrom.