Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Int J Cardiol. 2011 Jul 15;150(2):151-5. doi: 10.1016/j.ijcard.2010.03.006. Epub 2010 May 13.
Stent implantation can create vessel damage such as edge dissections. The objectives were i) to evaluate the frequency of edge dissections after stenting visible by intracoronary optical coherence tomography (OCT) in comparison with angiography. ii) to assess with OCT the plaque type left at the stent edges after implantation, and iii) to study whether there is an association between plaque type and dissections at stent edges.
Seventy-three consecutive patients (80 vessels) with OCT post-stent implantation were included in the study. By OCT, plaque type at stent edges and presence of edge dissection were assessed. Angiograms were analyzed by two independent observers to assess the presence of edge dissections.
Distal and proximal edges were visible by OCT in 72/80 and 45/80 vessels respectively. OCT and angiography agreed in the detection of 7 dissections at distal edge (κ=0.32) and 1 dissection at proximal edge (κ=0.22). Plaque type at distal edge was: fibrotic 55.6%, fibrocalcific 22.2%, fibroatheroma 15.3% and thin-cap fibroatheroma (TCFA) 6.9%. At proximal edge plaque type was: fibrotic 31.1%, fibrocalcific 33.3%, fibroatheroma 28.9% and TCFA 6.7%. In the distal edge, presence of edge dissection was significantly more frequent when the plaque type at the edge was fibrocalcific (43.8%) or lipid rich (37.5%) than when the plaque was fibrous (10%) p=0.009.
OCT showed higher sensitivity compared to angiography for the identification of edge dissections. A high proportion of patients showed lipid-rich plaques at stent edges. Plaque type at the stent edges has impact on the presence of edge dissections.
支架植入会导致血管损伤，如边缘夹层。本研究旨在：i）通过冠状动脉光学相干断层扫描（OCT）评估支架内边缘夹层的发生率，并与血管造影进行比较。ii）评估支架边缘残留的斑块类型，以及 iii）研究斑块类型与支架边缘夹层之间的关系。
本研究纳入 73 例（80 支血管）支架植入术后行 OCT 检查的连续患者。通过 OCT 评估支架边缘的斑块类型和边缘夹层的存在。由两名独立观察者分析血管造影结果，以评估边缘夹层的存在。
OCT 可清晰显示 72/80 支血管的远端边缘和 45/80 支血管的近端边缘。OCT 和血管造影在检测 7 处远端边缘夹层（κ=0.32）和 1 处近端边缘夹层（κ=0.22）方面具有一致性。远端边缘的斑块类型为：纤维斑块 55.6%、纤维钙化斑块 22.2%、纤维粥样斑块 15.3%和薄帽纤维粥样斑块（TCFA）6.9%。近端边缘的斑块类型为：纤维斑块 31.1%、纤维钙化斑块 33.3%、纤维粥样斑块 28.9%和 TCFA 6.7%。在远端边缘，当边缘斑块为纤维钙化（43.8%）或富含脂质（37.5%）时，边缘夹层的发生率显著高于纤维斑块（10%），p=0.009。
与血管造影相比，OCT 对边缘夹层的识别具有更高的敏感性。支架边缘有相当比例的患者存在富含脂质的斑块。支架边缘的斑块类型对边缘夹层的发生有影响。
