支架内再狭窄38例光学相干断层成像影像分析

目的分析支架内再狭窄患者光学相干断层成像(OCT)影像学表现特征。方法回顾性分析2016年1月至2018年12月在西京医院行冠状动脉造影诊断为支架内再狭窄并行OCT检查患者38例,共42处支架内再狭窄病变。支架内再狭窄时间为52.0(17.5,84.0)个月。根据发生时间分为支架内再狭窄时间≤20个月组(11例,12处病变,中位随访时间8.5个月)和支架内再狭窄时间>20个月组(27例,30处病变,中位随访时间75个月)。结果38例患者平均年龄为(62.84±11.08)岁,其中男性22例(57.9%),高血压病19例(50.0%),糖尿病17例(44.7%)。定量冠状动脉造影(QCA)分析结果显示,最小管腔直径为(0.88±0.55)mm,直径再狭窄率为(66.41±18.51)%。OCT对支架内再狭窄可能原因分析,支架膨胀不全、贴壁不良、支架直径偏小分别占21.1%、10.5%以及5.3%。OCT对血栓性质分析,血栓见于21.1%患者,其中红色血栓、白色血栓及混合血栓分别占2.6%、5.3%以及13.2%。支架内再狭窄时间>20个月组钙化(26.7%比8.3%,P=0.372)、薄纤维帽粥样硬化斑块(10.0%比0,P=0.556)、巨噬细胞(40.0%比8.3%,P=0.102)、斑块侵蚀(50.0%比16.7%,P=0.101)与支架内再狭窄时间≤20个月组发生率相比,差异均无统计学意义,但均有升高趋势,而脂质(60.0%比25.0%,P=0.040)差异有统计学意义。结论支架内再狭窄患者伴有支架膨胀不全或贴壁不良等手术操作因素,随着时间的延长支架内再狭窄患者新生斑块不稳定性有增加趋势。

Optical coherence tomographic analysis of in-stent restenosis in 38 patients after drug-eluting stent implantation

Objective To explore the imaging characteristics of in-stent stenosis in patients after drug-eluting stent(DES)implantation with optical coherence tomography(OCT).Methods A total of 38 patients with 42 DES in-stent restenosis(ISR)demonstrated by coronary artery angiography(CAG)in Xijing Hospital,from January 2016 to December 2018 were included in this study.Patient’s data were retrospectively analyzed.The eligible patients were divided into≤20-month group(patient n=11,lesion n=12,median follow-up time of 8.5 months)and>20-month group(patient n=27,lesion n=30,median follow-up time of 75 months)according to the duration of restenosis.Results The mean age of these 38 patients was(62.84±11.08)years old,including 22 male(57.9%)and 19 cases(50.0%)of hypertension and 17 cases(44.7%)of diabetes.The CAG characteristic demonstrated that the average restenosis in diameter was(66.41%±18.51%)with QCA.The OCT showed that stent undersize,malposition and under-expansion were present in 5.3%,10.5% and 21.1%of the population.The thrombus was found in 21.1% of the patients,including 2.6%of red thrombus,5.3% of white thrombus and 13.2% mixed thrombus.Compared with≥20-month restenosis group,The calcifi cation(26.7%vs.8.3%,P=0.372),TCFA(10.0%vs 0,P=0.556),erosion(50.0%vs.16.7%,P=0.101),and macrophage(40.0%vs.8.3%,P=0.102)had a trend of increase in patients>20-month restenosis follow-up group.Conclusions Procedural factors such as malposition and underexpansion were found in the in-stent restenosis patients The in-stent atherosclerotic plaque shows a trend of time-dependent instability.