Yao Zhu-hua, Matsubara Tetsuo, Inada Tsuyoshi, Suzuki Yasuyoshi, Suzuki Takahiko
Department of Cardiology, Toyohashi Heart Center, Toyohashi 441-8530, Japan.
Chin Med J (Engl). 2008 Mar 20;121(6):503-7.
Optical coherence tomography (OCT) is a new imaging modality with resolution of approximately 10 microm and can be employed to visualize intracoronary characteristics. Sirolimus-eluting stents (SES) are susceptible to late thrombosis due to delayed re-endothelialization over the stent struts, which may result in acute myocardial infarction or death. This study was designed to evaluate the re-endothelialization and neointimal coverage of SES with OCT 6 months and 12 months after implantation.
A total of 36 patients enrolled in the study underwent OCT examination 6 months (17 patients) and 12 months (19 patients) after SES implantation. The strut apposition to the vessel wall and neointimal coverage on SES struts were evaluated by OCT.
Forty-six SES and 6561 struts were analyzed. At 6 months, 3041 struts (98.7%) were well-apposed and 39 struts (1.3%) were malapposed. At 12 months, 3434 struts (98.6%) were well-apposed and 47 struts (1.4%) were malapposed. Furthermore, only 4 SES at 6 months (18.2%) and 10 SES at 12 months (41.7%) were fully covered by neointimal growth. The average neointimal thicknesses covering the analyzed struts at 6 months and 12 months were (42+/-28) microm and (88+/-32) microm, respectively. There were 1989 struts at 6 months (72.1%) and 1461 struts at 12 months (45.6%) with neointimal thickness <100 microm.
OCT was able to visualize the strut apposition to the vessel wall and neointimal coverage on SES struts. At 6-month and 12-month follow-up examinations most struts were covered with thin neointima, but few of the entire SES showed full coverage. To prevent late-stent thrombosis in the presence of uncovered stent struts, longer dual antiplatelet drugs therapy should be recommended.
光学相干断层扫描（OCT）是一种新的成像方式，分辨率约为10微米，可用于观察冠状动脉内的特征。西罗莫司洗脱支架（SES）由于支架小梁上的再内皮化延迟而易发生晚期血栓形成，这可能导致急性心肌梗死或死亡。本研究旨在用OCT评估SES植入后6个月和12个月时的再内皮化和新生内膜覆盖情况。
共有36例纳入本研究的患者在SES植入后6个月（17例患者）和12个月（19例患者）接受了OCT检查。通过OCT评估支架小梁与血管壁的贴壁情况以及SES小梁上的新生内膜覆盖情况。
分析了46个SES和6561个小梁。6个月时，3041个小梁（98.7%）贴壁良好，39个小梁（1.3%）贴壁不良。12个月时，3434个小梁（98.6%）贴壁良好，47个小梁（1.4%）贴壁不良。此外，6个月时只有4个SES（18.2%）和12个月时10个SES（41.7%）被新生内膜生长完全覆盖。6个月和12个月时覆盖分析小梁的新生内膜平均厚度分别为（42±28）微米和（88±32）微米。6个月时有1989个小梁（72.1%）和12个月时有1461个小梁（45.6%）新生内膜厚度<100微米。
OCT能够观察到支架小梁与血管壁的贴壁情况以及SES小梁上的新生内膜覆盖情况。在6个月和12个月的随访检查中，大多数小梁被薄新生内膜覆盖，但整个SES中很少有完全覆盖的情况。为防止存在未覆盖支架小梁时发生晚期支架血栓形成，应推荐更长时间的双联抗血小板药物治疗。
