经皮冠状动脉介入治疗后支架边缘夹层的光学相干断层成像评价

目的 应用高分辨率的光学相干断层成像（OCT）对支架术后支架边缘夹层的发生率及其预后进行评价.方法 选取2009年11月至2012年11月行经皮冠状动脉介入（PCI）治疗后接受OCT检查的患者,利用OCT对支架边缘的图像进行分析与测量,计算OCT观察到的支架边缘夹层的发生率,记录支架边缘夹层的撕裂深度、开口宽度、撕裂片最大长度等数据并进行分析,观察斑块的性质并随访12个月观察预后.结果 入选92例患者,扫描106枚支架,纳入分析的支架边缘区域184个,最终发现18例患者的20个支架部位和24个支架边缘出现夹层,应用OCT观察PCI术后夹层发生率为19.6％,明显高于造影发现.这些患者的特征是年龄更大（P＜0.001）、高血压（P=0.007）及吸烟（P=0.049）的更多,多发生于钙化斑块（P=0.002）、纤维斑块较少见（P=0.008）.随访12个月,仅被OCT发现的夹层患者与无夹层患者相比,主要不良心血管事件差异无统计学意义.结论 应用OCT观察发现PCI术后夹层的发生率明显高于造影,其中仅被OCT发现的夹层预后良好.

OCT analysis of stent edge dissection after PCI

Objective We sought to use optical coherence tomography which is a high-resolution modality to assess the rates of stent edge dissection after PCI. Clinical outcomes were follow up to one year after PCI. Methods From November 2010 to November 2012, all the patients with OCT post-PCI were enrolled. We calculated the incidence of stent edge dissection, detected the plaque at the stent edges, measured the dimension of the dissections, and evaluqted the outcome at 1 year afer PCI. Results In total 184 stent edges of 106 stents in 92 patients were analyzed. Dissections were detected at 24 edges of 20 stents in 18 patients. The group with stent edge dissection were older （P 〈 0.001）, had higher rate of hypertension （P=0.007）, smoker （P=0.049）, calcified plaque （P=0.002）, and lower rate of fibrotic plaque （P=0.008） in comparison to the group without dissection. Follow up to one year, the incidence of MACE has no significant difference between the patients with dissection seen only by OCT and the patients without dissection. Conclusions The incidence of OCT-detected stent edge dissection was 19.6%. The one can be seen only by OCT have favonrable prognosis.