Development of lipid-rich plaque inside bare metal stent: possible mechanism of late stent thrombosis? An optical coherence tomography study
Development of lipid-rich plaque inside bare metal stent: possible mechanism of late stent thrombosis? An optical coherence tomography study
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DOI：
10.1136/hrt.2010.194381
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发表时间：
2010-08-01
期刊：
影响因子：
5.7
通讯作者：
Jang, Ik-Kyung
中科院分区：
文献类型：
--
作者：
Hou, Jingbo;Qi, Hai;Jang, Ik-Kyung
目的应用光学相干断层扫描(OCT)技术研究曾置入裸金属支架的患者长期随访时支架内组织的特点。方法与结果1999-2006年间接受裸金属支架(BMS)置入术的患者1636例，其中39例(60个BMS)患者在2008年6月-2009年8月期间进行了重复插管和OCT成像。首次植入BMS到OCT成像的平均时间间隔为6.5+/-1.3年。16例患者(41%)20个支架(33.3%)出现富脂斑块病变。其余40例支架内可见纤维状内膜。富脂斑块组平均纤维帽厚度为56.7±5.8微米，脂弧为173±58。6名患者有近期斑块破裂的证据，另有6名患者有壁血栓。高血压和吸烟在这些患者中比纤维性炎症患者更常见。结论在既往植入BMS的患者中，存在富脂斑块，纤维帽较薄，并在随访后期复发缺血。这可能是晚期支架血栓形成的一个可能机制。
Aims To study in-stent tissue characteristics by optical coherence tomography (OCT) at long-term follow-up in patients with previous bare metal stent implantation.Methods and results Among 1636 patients who underwent bare metal stent (BMS) implantation between 1999 and 2006, 39 patients with 60 BMS who developed recurrent ischaemia underwent repeat catheterisation and OCT imaging between June 2008 and August 2009. The average time interval between initial BMS implantation and OCT imaging was 6.5 +/- 1.3 years. A lesion that had features of lipid-rich plaque was found in 20 stents (33.3%) in 16 patients (41%). Fibrous intima was observed in the remaining 40 stents. In the group with lipid-rich plaque, average fibrous cap thickness was 56.7 +/- 5.8 mu m and lipid arc was 173 +/- 58. Six patients had evidence of recent plaque disruption and another six patients had mural thrombus. Hypertension and smoking were more common in these patients than in those with fibrous intima.Conclusions Lipid-rich plaque with a thin fibrous cap was seen in patients with previous BMS implantation and recurrent ischaemia at late follow-up. This may be one possible mechanism for late stent thrombosis.