光学相干断层显像评价药物洗脱支架置入后内膜增殖和血栓形成

目的 应用光学干涉断层显像(OCT)技术评价雷帕霉素洗脱支架(SES)置入后3个月和2年后内膜增殖和支架内血栓形成情况.方法 对3个月组进行SES置入后3个月的OCT随访观察,对2年组进行SES置入后2年的随访观察.测量每一个支架支撑杆表面的新生内膜厚度,并评估无内膜覆盖支架支撑杆及支架内血栓形成情况.结果 2年组的内膜厚度显著大于3个月组(71±93)μm比(29±41)μm,P＜0.01],而2年组中的无内膜覆盖支架支撑杆的比例明显低于3个月组(5%比15%,P＜0.01).2年组与3个月组无内膜覆盖支撑杆患者的比例差异无统计学意义(81%比95%,P＞0.05).两组中均有14%的患者出现无临床症状的支架内血栓形成.结论 SES置入后3个月到2年新生内膜的增生在不断进展,无内膜覆盖支撑杆数明显减少.但是直到支架置入后2年,多数患者体内仍然存在部分无内膜覆盖的支架支撑杆.

Evaluation of neointimal coverage and thrombosis at 3 months and 2 years post sirolimus-eluting stent implantation by optical coherence tomography

Objective To evaluate the short-and long-term prevalence of persistent uncovered struts and in-stent thrombus after sirolimus-eluting stent(SES)implantation by optical coherence tomography (OCT).Methods OCT was performed for 31 SES in 21 patients at 3 months and for 30 SES in 21 patients at 2 years post SES implantation.Thickness of new intima inside each strut was measured and thickness equal to 0 μm was defined as an uncovered strut.Existence of in-stent thrombus was also evaluated.Results A total of 4545 struts and 3707 struts were evaluated at 3 months and at 2 years post SES implantation,respectively.New intima at 2 years was significantly thicker than that at 3 months(71±93)μm vs.(29±41)μm,P＜0.01].Percent of uncovered struts at 2 years was significantly lower than that at 3 months(5%vs.15%,P＜0.01).Prevalence of uncovered struts was similar at 2 years and at 3 months(81%vs.95%,P＞0.05).subclinical thrombus was recognized in 14%patients at 3 months and 2 years post SES implantation.Conclusions Neointimal coverage inside the SES is a continuous process and the number of uncovered struts decreased from 3 months to 2 years after SES implantation.Few uncovered struts could still be visualized in the majority of patients at 2 years post SES implantation.