| 王学懂 贾海波 黄幸涛 张若溪 陈树源 侯静波.冠状动脉慢性完全闭塞病变介入治疗后的OCT 研究[J].,2015,15(32):6296-6301 |
| 冠状动脉慢性完全闭塞病变介入治疗后的OCT 研究 |
| Different Vessel Response between Chronic Total Occlusions(CTO) andnon-CTO Lesion after Sirolimus-eluting Stent Implantation A Serial OpticalCoherence Tomography Study |
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| DOI： |
| 中文关键词: 慢性完全闭塞病变 西罗莫司药物洗脱支架 血管反应 光学相干断层成像技术 |
| 英文关键词: Chronic total occlusions Sirolimus-eluting stents Vessel response Optical coherence tomography |
| 基金项目:国家自然科学基金项目（81271675） |
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| 中文摘要: |
| 目的：通过光学相干断层成像技术（Optical Coherence Tomography，OCT）观察冠脉慢性完全闭塞病变（Coronary Total
Occlusion，CTO）与非闭塞性病变在植入药物洗脱支架（Sirolimus-eluting Stents, SES）后的血管反应（新生内膜覆盖情况和支架小
梁贴壁情况）。方法：共入选64 位患者，分成CTO组、富含脂质斑块（Lipid-rich Plaque, LRP）组与非富含脂质斑块（non-LRP）组。分
别于术前、术后即刻、6 月随访时行OCT 检查。结果：术后即刻，CTO 组与LRP 组支架贴壁不良的发生率要高于non-LRP 组
（3.03 %%，2.58%%vs.0.64 %，P＝0.0219）；组织脱垂、支架内血栓的发生率从高到低依次为LRP 组、CTO 组、non-LRP 组（14.99
%vs.11.00%vs. 6.41 %，P＜0.001；3.81%vs. 2.39 %vs. 1.07 %，P＝0.0119）。6 月随访时，三组比较（CTO 组vs. LRP组vs. non-LRP
组），CTO 组贴壁不良发生率（5.0 %vs.1.04 %vs.0.4 %，P＝0.002）、伴有支架小梁裸露的截面数（23.4 %vs.8.2 %vs.6.6 %，P＜
0.001)以及伴有支架小梁突出的截面数（30.8 %vs.9.6%vs.9.6 %，P＜0.001）较高。结论：植入SES 后不同的血管反应和冠脉原始
病变特征有关。CTO 病变与LRP病变在植入支架即刻更易于发生贴壁不良、组织脱垂和支架内血栓。6 个月随访时，CTO 病变的
血管内皮化和愈合延迟，且贴壁不良的发生率较高。 |
| 英文摘要: |
| Objective:To investigate the neointimal coverage and malapposition of sirolimus-eluting stent in treatment of chronic
total occlusions (CTOs) and non-CTO lesions (including lipid-rich plaque and non-lipid-rich plaque) by optical coherence tomography.Methods:We enrolled 64 patients (CTO: n=29 stents/21 patients, lipid-rich plaque: n=33 stents/26 patients, and non-lipid-rich plaque:
n=21 stents/17 patients) with 68 target vessels and examined lesion characteristics by using OCT at pre- and post-sirolimus-eluting stents
(SES) implantation, and 6 months' follow-up. Lipid rich plaque was defined as the plaque with lipid content in ≥ 2 quadrants.
Non-lipid-rich plaque consists of fibrous, fibrocalcific plaque, and lipid plaque with less than 2 quadrants lipid content.Results:The
incidence of incomplete stent apposition was higher in CTO and lipid rich plaque group compared with those with non-lipid rich plaque
(3.03 %, 2.58%vs.0.64 %, P=0.0219). The tissue protrusion(14.99%vs. 11.00 %vs. 6.41 %, P<0.001) and intra-stent thrombus(3.81 %
vs. 2.39 %vs.1.07 %, P=0.0119) after percutaneous coronary intervention were observed most frequently in lipid-rich plaque group than
CTO group and non-lipid rich plaque group. At 6 months' follow-up, the incidence of malapposition (5.0 % vs. 1.04 % and 0.4 %, P=
0.002), the cross section with uncovered struts (23.4%vs. 8.2 %and 6.6 %, P<0.001), and protrusion (30.8 % vs.9.6 %and 9.6 %, P<0.
001) was significantly greater in patients with CTO than those with lipid rich plaque and non-lipid rich plaque. Although the incidence of
in-stent thrombus was non-significantly higher in CTO than LRP and non-LRP (9.4%vs.3.1 %vs.0, P=0.26), there was no adverse event
in these patients with CTO.Conclusion:Initial lesion morphology is contributable to coronary artery response to DES after stent
implantation. CTOs and lipid rich plaque is associated with higher incidence of malapposition, tissue protrusion, and mural thrombus
after stenting. At 6 months follow up, the vessels with CTO lesion was characterized by delayed healing and higher incidence of
malapposition. |
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