Kochman Janusz, Pietrasik Arkadiusz, Rdzanak Adam, Jąkała Jacek, Zasada Wojciech, Scibisz Anna, Kołtowski Lukasz, Proniewska Klaudia, Pociask Elżbieta, Legutko Jacek
1st Department of Cardiology, Medical University of Warsaw, Poland.
Kardiol Pol. 2014;72(6):534-40. doi: 10.5603/KP.a2013.0317. Epub 2013 Dec 2.
The amount of data comparing intravascular ultrasound (IVUS) and optical coherence tomography (OCT) for the detection of stent coverage in clinical settings is limited.
To make a qualitative and quantitative assessment of the vascular healing patterns in patients after stent implantations visualised by both IVUS and OCT.
Images were obtained in patients with clinical symptoms of angina, who had had a bare metal stent implanted in the previous 12 months. Angiography, IVUS and OCT were performed in 14 coronary arteries. Measurements of stent, lumen and neo-intima areas and dimensions were performed in stented regions and in both 10 mm references. IVUS, OCT, and angiographic data were compared in matched regions. Off-line analyses were performed by an independent core lab.
14 stents were imaged without any procedural complications. The nominal stent length was 28 ± 4.5 mm. OCT was the most accurate technique for assessing stent length (28.12 ± 6.8 mm), while QCA underestimated length due to foreshortening (22.16 ± 6.39 mm) and IVUS was vulnerable to random error due to discontinuous pullbacks and vessel movements (24.21 ± 7.90 mm). Minimum lumen area (MLA) and minimum lumen diameter (MLD) in reference sites were comparable in IVUS and OCT, whereas there were significant differences between these two modalities for MLA (3.30 ± 1.49 vs. 2.19 ± 1.30 mm², p = 0.0046) and for MLD (2.42 ± 0.51 vs. 1.58 ± 0.56 mm², p = 0.0023) in stented segments. There was a slight overestimation of lumen volume (130.18 ± 70.61 vs. 117.82 ± 67.02 mm³, p = 0.7256),a marked overestimation of stent volume (179.29 ± 97.58 vs. 226.46 ± 108.76 mm³, p = 0.0544) and a statistically significant difference in the neointima volume (49.11 ± 39.70 vs. 108.64 ± 43.77 mm³, p = 0.0060) by IVUS compared to OCT. Mean neointima burden in IVUS was much smaller than in OCT (20.79 ± 14.27% vs. 58.16 ± 18.25%, p = 0.0033).
OCT can precisely quantify struts coverage and is more accurate than IVUS in the assessment of vascular healing in patients after stent implantation.
在临床环境中，比较血管内超声（IVUS）和光学相干断层扫描（OCT）检测支架覆盖情况的数据量有限。
对通过IVUS和OCT可视化的支架植入术后患者的血管愈合模式进行定性和定量评估。
对有临床心绞痛症状、在过去12个月内植入裸金属支架的患者进行成像。对14条冠状动脉进行血管造影、IVUS和OCT检查。在支架置入区域以及两个10mm参考区域测量支架、管腔和新生内膜的面积及尺寸。对匹配区域的IVUS、OCT和血管造影数据进行比较。由独立的核心实验室进行离线分析。
对14个支架进行成像，无任何操作并发症。标称支架长度为28±4.5mm。OCT是评估支架长度最准确的技术（28.12±6.8mm），而QCA由于缩短而低估了长度（22.16±6.39mm），IVUS由于回撤不连续和血管移动易受随机误差影响（24.21±7.90mm）。IVUS和OCT测量的参考部位最小管腔面积（MLA）和最小管腔直径（MLD）具有可比性，而在支架节段中，这两种方法在MLA（3.30±1.49 vs. 2.19±1.30mm²，p = 0.0046）和MLD（2.42±0.51 vs. 1.58±0.56mm²，p = 0.0023）方面存在显著差异。IVUS对管腔容积的估计略有高估（130.18±70.61 vs. 117.82±67.02mm³，p = 0.7256），对支架容积有明显高估（179.29±97.58 vs. 226.46±108.76mm³，p = 0.0544），与OCT相比，IVUS测量的新生内膜容积存在统计学显著差异（49.11±39.70 vs. 108.64±43.77mm³，p = 0.0060）。IVUS测量的平均新生内膜负荷远小于OCT（20.79±14.27% vs. 58.16±18.25%，p = 0.0033）。
OCT能够精确量化支架小梁覆盖情况，在评估支架植入术后患者的血管愈合方面比IVUS更准确。
