Combined use of optical coherence tomography and intravascular ultrasound imaging in patients undergoing coronary interventions for stent thrombosis
Combined use of optical coherence tomography and intravascular ultrasound imaging in patients undergoing coronary interventions for stent thrombosis
复制标题
DOI：
10.1136/heartjnl-2012-302183
复制
发表时间：
2012-08-01
期刊：
影响因子：
5.7
通讯作者：
Macaya, Carlos
中科院分区：
文献类型：
--
作者：
Alfonso, Fernando;Dutary, Jaime;Macaya, Carlos
目的 本前瞻性研究旨在评估光学相干断层扫描 (OCT) 与血管内超声 (IVUS) 相比对支架内血栓形成 (ST) 患者的诊断价值。 设计和设置 尽管 IVUS 在这种情况下的作用已被描述，但 OCT 对 ST 患者的潜在诊断价值仍不清楚。大学医院导管实验室。 患者和干预措施 分析了连续 15 名在 IVUS/OCT 影像引导下接受挽救性冠状动脉介入治疗的 ST 患者。平均结果测量 干预前后 OCT 和 IVUS 结果的分析和比较。结果 干预前，OCT 可视化所有患者中的主要血栓（血栓面积 4.7 +/- 2.5 mm(2)，支架阻塞 82 +/- 14%）。最小支架面积为 4.7 +/- 2.1 mm(2)，导致支架严重扩张不足（扩张 60 +/- 21%）。尽管红色或混合血栓（14 名患者）引起部分支柱阴影（总长度 12.3 +/- 6 mm），但贴壁不良（6 名患者）、流入流出疾病（5 名患者）、未覆盖的支柱（9 名患者）和相关的支架内再狭窄（5 名患者，4 名显示新生动脉粥样硬化）已被清楚地识别。 IVUS 披露了类似的发现，但血栓-管腔界面和支柱贴壁不良的可视化较差，并且未能识别未覆盖的支柱和相关的新生动脉粥样硬化。干预后，OCT 显示血栓负荷 (2.4 +/- 1.6 mm(2)) 和支架阻塞 (24 +/- 14%) 减少，支架面积 (6.8 +/- 2.9 mm(2)) 和扩张 (75 +/- 21%) 有所改善（所有 p
Objective This prospective study sought to assess the diagnostic value of optical coherence tomography (OCT) compared with intravascular ultrasound (IVUS) in patients presenting with stent thrombosis (ST).Design and setting Although the role of IVUS in this setting has been described, the potential diagnostic value of OCT in patients suffering ST remains poorly defined. Catheterization Laboratory, University Hospital.Patients and interventions Fifteen consecutive patients with ST undergoing rescue coronary interventions under combined IVUS/OCT imaging guidance were analysed.Mean outcome measures Analysis and comparison of OCT and IVUS findings before and after interventions.Results Before intervention, OCT visualised the responsible thrombus in all patients (thrombus area 4.7 +/- 2.5 mm(2), stent obstruction 82 +/- 14%). Minimal stent area was 4.7 +/- 2.1 mm(2) leading to severe stent underexpansion (expansion 60 +/- 21%). Although red or mixed thrombus (14 patients) induced partial strut shadowing (total length 12.3 +/- 6 mm), malapposition (six patients), inflow-outflow disease (five patients), uncovered struts (nine patients) and associated in-stent restenosis (five patients, four showing neoatherogenesis) was clearly recognised. IVUS disclosed similar findings but achieved poorer visualisation of thrombus-lumen interface and strut malapposition, and failed to recognise uncovered struts and associated neoatherosclerosis. After interventions, OCT demonstrated a reduced thrombus burden (2.4 +/- 1.6 mm(2)) and stent obstruction (24 +/- 14%) with improvements in stent area (6.8 +/- 2.9 mm(2)) and expansion (75 +/- 21%) (all p