Gonzalo Nieves, Serruys Patrick W, Okamura Takayuki, van Beusekom Heleen M, Garcia-Garcia Hector M, van Soest Gijs, van der Giessen Wim, Regar Evelyn
Thoraxcenter, Erasmus MC, Rotterdam 3015-CE, The Netherlands.
Am Heart J. 2009 Aug;158(2):284-93. doi: 10.1016/j.ahj.2009.06.004.
Stent restenosis is an infrequent but poorly understood clinical problem in the drug-eluting stent era. The aim of the study was to evaluate the morphologic characteristics of stent restenosis by optical coherence tomography (OCT).
Patients (n = 24, 25 vessels) presenting with angiographically documented stent restenosis were included. Quantitative OCT analysis consisted of lumen and stent area measurement and calculation of restenotic tissue area and burden. Qualitative restenotic tissue analysis included assessment of tissue structure, backscattering and symmetry, visible microvessels, lumen shape, and presence of intraluminal material.
By angiography, restenosis was classified as diffuse, focal, and at the margins in 9, 11, and 5 vessels, respectively. By OCT, restenotic tissue structure was layered in 52%, homogeneous in 28%, and heterogeneous in 20%. The predominant backscatter was high in 72%. Microvessels were visible in 12%. Lumen shape was irregular in 28% and there was intraluminal material in 20%. The mean restenotic tissue symmetry ratio was 0.58 +/- 0.19. Heterogeneous and low scattering restenotic tissue was more frequent in focal (45.5% and 54.5%, respectively) than in diffuse (0 and 11.1%) and margin restenosis (0 and 0%) (P = .005 for heterogeneous, P = .03 for low scattering). Restenosis patients with unstable angina symptoms presented more frequently irregular lumen shape (60 vs 6.7%, P = .007). Stents implanted </=12 months ago had more frequently restenotic tissue with layered appearance (84.6% vs 16.7%, P = .003).
We demonstrate the ability of OCT to identify differential patterns of restenotic tissue after stenting. This information could help in understanding the mechanism of stent restenosis.
在药物洗脱支架时代，支架再狭窄是一个少见但了解甚少的临床问题。本研究的目的是通过光学相干断层扫描（OCT）评估支架再狭窄的形态学特征。
纳入血管造影证实存在支架再狭窄的患者（n = 24，25支血管）。定量OCT分析包括管腔和支架面积测量以及再狭窄组织面积和负荷的计算。定性再狭窄组织分析包括组织结构、背向散射和对称性、可见微血管、管腔形状以及腔内物质的评估。
通过血管造影，再狭窄分别在9支、11支和5支血管中被分类为弥漫性、局灶性和边缘性。通过OCT，再狭窄组织结构分层的占52%，均匀的占28%，异质性的占20%。主要背向散射高的占72%。微血管可见的占12%。管腔形状不规则的占28%，腔内有物质的占20%。再狭窄组织平均对称比为0.58±0.19。异质性和低散射再狭窄组织在局灶性再狭窄中比弥漫性（分别为45.5%和54.5%，弥漫性为0和11.1%）和边缘性再狭窄（均为0）更常见（异质性P = 0.005，低散射P = 0.03）。有不稳定型心绞痛症状的再狭窄患者管腔形状不规则更常见（60%对6.7%，P = 0.007）。植入时间≤12个月的支架再狭窄组织分层外观更常见（84.6%对16.7%，P = 0.003）。
我们证明了OCT识别支架置入后再狭窄组织不同模式的能力。这些信息有助于理解支架再狭窄的机制。
