Skirball Center for Cardiovascular Research, Cardiovascular Research Foundation, Orangeburg, New York 10962, USA.
JACC Cardiovasc Imaging. 2010 Jan;3(1):76-84. doi: 10.1016/j.jcmg.2009.09.018. Epub 2010 Jan 12.
This study aimed to evaluate the accuracy of optical coherence tomography (OCT) in analyzing the neointimal response to several drug-eluting stent (DES) types by comparing OCT images acquired in vivo with corresponding histological specimens using a nondiseased porcine injury model.
Optical coherence tomography is emerging as a promising endovascular imaging tool for the evaluation of neointimal response after DES implantation.
A total of 84 stents were implanted-22 ML Vision (Abbott Vascular, Santa Clara, California), 22 Xience V (Abbott Vascular), 20 Endeavor (Medtronic, Minneapolis, Minnesota), and 20 Taxus Liberté (Boston Scientific, Natick, Massachusetts) stents-in normal porcine coronary arteries and were harvested at 28 (n=42) and 90 (n=42) days, with the different stent types equally distributed between the 2 follow-up periods. At termination, morphometric evaluation using OCT imaging was performed in all stented arteries. Histological morphometric analysis was performed and correlated with OCT.
A total of 622 OCT-histology matched frames acquired from all stent designs were analyzed. The luminal (13.7%) and stent (6.1%) areas were consistently larger by OCT compared with histology. The mean neointimal thickness was very similar between techniques (approximately 3.27% variation). There was a high correlation between OCT and histology for the evaluation of neointimal area (R2=0.804), luminal area (R2=0.825), and neointimal thickness (R2=0.789). Correlation for total stent area was poor (R2=0.352). Although the proportion of individual struts determined to be uncovered by OCT and histology was similar, there was significant variation in the estimation of strut coverage between OCT and histology when the neointimal thickness was between 20 and 80 microm. This variation converged for neointimal thicknesses between 80 and 100 microm.
Subtle differences in neointimal formation induced by current DES can be reproducibly analyzed in vivo by OCT. However, OCT measurement of stent area seems to have less correlation with histology.
本研究旨在通过使用非病变猪损伤模型，将体内获得的光学相干断层扫描（OCT）图像与相应的组织学标本进行比较，评估几种药物洗脱支架（DES）类型对新生内膜反应的准确性。
OCT 作为一种有前途的血管内成像工具，正在用于评估 DES 植入后的新生内膜反应。
将 84 个支架（22 个 ML Vision（雅培血管，圣克拉拉，加利福尼亚州），22 个 Xience V（雅培血管），20 个 Endeavor（美敦力，明尼苏达州明尼阿波利斯）和 20 个 Taxus Liberté（波士顿科学，马萨诸塞州纳提克））植入正常猪冠状动脉中，并在 28 天（n=42）和 90 天（n=42）进行收获，不同的支架类型在两个随访期内均匀分布。在终止时，对所有支架动脉进行 OCT 成像的形态计量评估。对所有支架设计均进行了 OCT 组织学形态计量分析，并与 OCT 相关联。
共分析了来自所有支架设计的 622 个 OCT-组织学匹配的帧。与组织学相比，OCT 测量的管腔（13.7％）和支架（6.1％）区域始终更大。两种技术之间的平均新生内膜厚度非常相似（约 3.27％的差异）。OCT 和组织学在评估新生内膜面积（R2=0.804）、管腔面积（R2=0.825）和新生内膜厚度（R2=0.789）方面具有高度相关性。对于支架总面积的相关性较差（R2=0.352）。尽管通过 OCT 和组织学确定的单个支架未被覆盖的比例相似，但当新生内膜厚度在 20 至 80μm 之间时，OCT 和组织学之间对支架覆盖率的估计存在显著差异。当新生内膜厚度在 80μm 至 100μm 之间时，这种差异趋于收敛。
通过 OCT 可以在体内重复分析当前 DES 引起的新生内膜形成的细微差异。然而，OCT 对支架面积的测量似乎与组织学的相关性较小。
