光学相干断层成像评价药物洗脱支架置入术后晚期支架贴壁不良

目的 探讨药物洗脱支架(DES)置入术后晚期支架贴壁不良的特点.方法 分析32例(包括51支血管、共置入71个支架)置入DES 1年后(14.8±5.2)个月]行光学相干断层成像(OCT)检查的患者资料,对支架节段的OCT图像每间隔0.5 mm取1帧图像进行分析,找出贴壁不良的支架金属结构,测量支架到参照血管内壁的距离及支架表面内膜厚度,分析晚期支架贴壁不良的特点.结果 OCT检查在7例(21.9%)患者中检出支架贴壁不良,其中4例合并支架段血管的正性重构,1例重叠置入支架,2例发现由血栓覆盖支架金属结构,7例患者随访期间无心脏不良事件发生.97.6%的支架金属结构完全贴壁并不同程度的内膜覆盖,2.4%的支架金属结构贴壁不良,包括1.2%的支架金属结构位于血管分支开口.位于血管分支开口的支架金属结构与其他贴壁不良支架表面的内膜覆盖厚度差异无统计学意义(0.06±0.05)mm比(0.05±0.03)mm,P>0.05].绪论晚期支架贴壁不良见于DES置入最初的贴壁不良、血管壁正性重构、重叠置入支架以及支架金属结构位于分支血管开口;贴壁不良的支架金属结构表面亦有不同程度的内膜覆盖.

Evaluation of the late stent malapposition after drug-during stent implantation by optical coherence tomography

Objective To evaluate the characteristic of late stent malapposition after drug-eluting stent implantation by optical coherence tomography (OCT). Methods The study comprised of 32 patients (target vessels: 51, total stents: 71) underwent drug eluting stent implantation one year agoaverage (14.8±5.2) months]. OCT images of the stent were analyzed at interval of 0. 5 mm. The stent malapposition was detected, the thickness of intima and gap between the stem strut and vessel wall were measured. Results Stent malapposition was detected in 7 patients without clinical cardiac events, including positive remodeling (n =4), overlapping stents (n = 1) and stent struts covered with thrombus (n = 2). Stent strut apposition with complete intima coverage was about 97.6%, stent struts malapposition was 2.4% including half of struts located at the ostium of side branch. The intima coverage of stent struts is similar between the struts at the side branch and others(0.06 ± 0.05) mm vs. (0.05 ± 0.03) mm, P > 0.05]. Conclusion The causes of late stem malapposition include the primary malapposition after stent implantation, positive remodeling, overlapping stents and stent struts located at the astium of side branch.Thinner infima coverage was also observed on the stent struts with malapposition.