摘要
目的评价光学相干断层成像(optical coherence tomography,OCT)在冠状动脉临界病变介入诊断与治疗中的可行性与有效性。方法在获得患者知情同意后,对来自15例患者的共16处冠状动脉造影结果显示狭窄程度(最小管腔直径/参照管腔直径)介于40%和70%之间的病变(即临界病变)行冠状动脉内OCT检查,评价病变狭窄程度、脂质核心大小、纤维帽的厚度、是否存在斑块破裂、是否伴有血栓形成以及斑块钙化程度。根据检查结果对伴随临床症状和心电图改变的易损斑块进行介入治疗。支架置入术后重复OCT检查,判断支架是否充分覆盖病变、与血管壁贴合情况,是否有斑块组织通过支架网眼突入管腔,以及局部是否存在微小夹层。结果入选的16处病变中的14处成功行OCT检查并获取满意图像。检查结果显示14处病变中有10处病变狭窄程度超过50%,并且脂质核心较大、纤维帽厚度小于65μm,判定以上10处病变为易损斑块,行冠状动脉内支架置入术。对其中2处伴有斑块破裂、局部形成夹层的病变行球囊预扩张后也行OCT检查,可见明显内膜撕裂、夹层形成。10处病变支架置入术后复查OCT显示支架均充分覆盖病变,其中2处支架与血管壁贴合不良,3处发生斑块组织明显突入管腔,有2处支架部分节段释放不充分。其余4处病变脂质核心较小,纤维帽厚度大于65μm,无斑块破裂表现,未行冠状动脉介入治疗。结论冠状动脉内OCT是一种判定冠状动脉病变特征的有效手段,对诊断易损斑块、制定经皮冠状动脉介入治疗策略以及评价支架置入术后即刻效果具有重要意义。
Objective To evaluate the feasibility and efficacy of optical coherence tomography （OCT） in interventional diagnosis and ＂treatment of borderline coronary artery disease. Methods Sixteen 40% -70% angiographically stenotic lesions from 15 patients were enrolled in the current study. Intravascular OCT was applied to each lesion after informed consent was obtained to evaluate stenosis percentage, size of lipid core, thickness of fibrous cap, existence of plaque rupture, and presence of thrombosis or calcification. Therapeutic strategies were made according to OCT outcomes as well as clinical symptoms and electrocardiographic changes. Stent coverage, apposition, and tissue prolapse between stent struts were determined in the patients undertaken pereutaneous coronary intervention （PCI）. Results Qualitative OCT images were obtained in 14 lesions. Ten lesions were greater than 50% stenosis, with large lipid core and fibrous cap thinner than 65 p.m, and plaque ruptures were noted in 2 of the lesions. PCI were performed in these 10 lesions. Two lesions underwent predilatation and significant intima tearings and dissections were detected with OCT. Repeated OCT after stent implantation showed complete coverage in all 10 lesions. Focal incomplete apposition were noted in 2 lesions. Significant tissue prolapse occurred in 3 lesions and segmental incomplete deployment of stent in 2 lesions. The remaining 4 lesions had small lipid cores, thick fibrous caps but with no plaque ruptures, thus PCI was not performed. Conclusion Intracoronary OCT is an effective tool to determine features of coronary lesions. It plays an important role in diagnosis of vulnerable lesions, strategy-making in treating borderline coronary artery disease and evaluation of immediate result of PCI.
出处
《中国介入心脏病学杂志》
2007年第2期67-69,共3页
Chinese Journal of Interventional Cardiology
基金
黑龙江省青年基金(QC06C057)
