Safety and feasibility of frequency domain optical coherence tomography to guide decision making in percutaneous coronary intervention
Safety and feasibility of frequency domain optical coherence tomography to guide decision making in percutaneous coronary intervention
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DOI：
10.4244/eijv6i5a97
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发表时间：
2010-11-01
期刊：
影响因子：
6.2
通讯作者：
Prati, Francesco
中科院分区：
文献类型：
--
作者：
Imola, Fabrizio;Mallus, Maria Teresa;Prati, Francesco
目的：这一单一中心注册的目的是评估频域光学相干断层扫描(FD-OCT)系统在冠状动脉介入治疗中的安全性和可行性。方法和结果：90例不稳定或稳定的冠状动脉疾病患者纳入研究。对第一组40名患者(第1组)进行OCT成像，以评估不明确/中间病变(第1组24名患者在经皮冠状动脉介入治疗后也进行OCT检查，以评估支架部署情况)；在第二组50名患者(第2组)中，评估支架部署的充分性。因此，74例患者在支架植入后进行了FD-OCT检查。B2型病变占72.2%，C型病变占20.3%。FD-OCT回撤(从建立到回撤完成)的平均时间为2.1分钟，除1例(99.1%)外，其余均成功。没有患者经历死亡、心肌梗死、紧急血管重建术、栓塞、危及生命的心律失常、冠状动脉夹层、长期和严重的血管痉挛以及造影剂肾病等重大并发症。在模糊病变组中，60%的患者接受了经皮冠状动脉介入治疗，而在其他组中，有60%的患者推迟了经皮冠状动脉介入治疗。共113个支架(33.6%铬钴支架，66.4%药物洗脱支架)进行了OCT成像。OCT结果导致74名患者中有24名(32%)接受了额外的干预：15名患者进一步球囊充气，9名患者进行了额外的支架置入，2名患者同时接受了两种治疗。在临床随访(4.6+/-3.，2个月)时，无死亡、急性心肌梗死和支架血栓形成病例，2例患者因心绞痛复发而行血管重建术。结论：本研究表明FD-OCT是一种安全可行的冠状动脉介入治疗技术。随机研究将证实使用FD-OCT是否会改善临床结果。
Aims: The purpose of this single centre registry is to assess safety and feasibility of the frequency domain optical coherence tomography (FD-OCT) system during coronary interventions.Methods and results: Ninety patients with unstable or stable coronary artery disease were included in this study. OCT imaging was performed in a first group of 40 patients (group 1), to evaluate ambiguous/intermediate lesions (24 patients in group 1 had OCT also done post-PCI, for assessment of stent deployment); and in a second group of 50 patients (group 2), to address the adequacy of stent deployment. Therefore, 74 patients underwent FD-OCT after stent implantation. A complex-lesion population was studied (B2 type lesion=72.2% and C type lesion=20.3%). The mean time of a FD-OCT pull-back (from the set up to the completion of the pull back) was 2.1 min and in all but one (99.1%) the procedure was successful. No patients experienced major complications in terms of death, myocardial infarction, emergency revascularisation, embolisation, life-threatening arrhythmia, coronary dissection, prolonged and severe vessel spasm and contrast induced nephropathy. In the ambiguous lesion group, 60% of patients were treated with PCI, whilst in the others, PCI were deferred. In total, 113 deployed stents (33,6% chromium cobalt stent, 66,4% drug eluting stent) were imaged with OCT. OCT findings led to additional interventions in 24 out of 74 patients (32%): 15 had further balloon inflations, nine had additional stent deployment whilst two had both treatments. At clinical follow-up, (4.6 +/- 3.,2 months), there were no death, acute myocardial infarctions and cases of stent thrombosis, whilst two patients underwent revascularisation for recurrence of angina.Conclusions: The present registry shows that FD-OCT is a feasible and safe technique for guidance of coronary interventions. Randomised studies will confirm whether the use of FD-OCT will improve the clinical outcome.