Liu Rui, Jiang Yongjun, Xiong Yunyun, Li Min, Ma Minmin, Zhu Wusheng, Yin Qin, Li Wei, Xu Gelin, Liu Xinfeng
Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China.
Department of Neurology, Jinling Hospital, Second Military Medical University, Nanjing, China
J Endovasc Ther. 2015 Dec;22(6):942-9. doi: 10.1177/1526602815610116. Epub 2015 Oct 13.
To evaluate the rate of stent malapposition, plaque prolapse, and fibrous cap rupture detected by optical coherence tomography (OCT) after carotid artery stenting (CAS) based on the presence of lipid-rich plaque, which may be associated with acute stent thrombosis.
A retrospective study was conducted involving 26 consecutive patients who underwent CAS with OCT imaging acquired before stent deployment and after stent dilation. Adequate imaging quality could not be obtained in 6 patients (out-of-screen images and residual blood), which left 20 patients (mean age 63 years; 13 men) for analysis. Plaque characteristics were determined from 500 selected OCT cross sections; a lipid-rich plaque was defined by lipid present in ≥2 quadrants. Cross-sectional OCT images within the stented segment were evaluated at 1-mm intervals for the presence of malapposition, plaque prolapse, and fibrous cap rupture. The data were compared between patients with and without lipid-rich plaques. The patients were examined at 6 months to determine the degree of in-stent restenosis (ISR).
Patients with lipid-rich plaque demonstrated a higher rate of embedded stent struts (29.4% vs 23.7%, p<0.001) and a lower rate of well apposed struts (54.6% vs 59.6%, p<0.001) compared to patients with non-lipid-rich plaque. Rates of plaque prolapse (65.5% vs 49.1%, p<0.001) and fibrous cap rupture (65.5% vs 49.1%, p<0.001) were significantly higher in patients with lipid-rich plaque. ISR ranged from none to 42% in 12 patients; malapposed stent struts and fibrous cap ruptures were not more frequent in the patients with obvious ISR. The 8 patients with no obvious restenosis still had malapposed struts, embedded struts, plaque prolapse, and fibrous cap rupture.
Embedded stent struts, plaque prolapse, and fibrous cap rupture were more frequent and well-apposed stent struts were less frequent after CAS in patients with lipid-rich plaque.
基于富含脂质斑块的存在情况，评估光学相干断层扫描（OCT）检测到的颈动脉支架置入术（CAS）后支架贴壁不良、斑块脱垂和纤维帽破裂的发生率，这些情况可能与急性支架内血栓形成有关。
进行一项回顾性研究，纳入26例连续接受CAS的患者，在支架置入前和支架扩张后获取OCT图像。6例患者（图像超出屏幕范围和残留血液）未获得足够的成像质量，剩余20例患者（平均年龄63岁；13例男性）进行分析。从500个选定的OCT横截面确定斑块特征；富含脂质斑块定义为在≥2个象限中存在脂质。以1毫米间隔评估支架段内的OCT横截面图像，以确定是否存在贴壁不良、斑块脱垂和纤维帽破裂。比较有和没有富含脂质斑块患者的数据。在6个月时检查患者以确定支架内再狭窄（ISR）程度。
与没有富含脂质斑块的患者相比，富含脂质斑块的患者显示出更高的支架支柱嵌入率（29.4%对23.7%，p<0.001）和更低的良好贴壁支柱率（54.6%对59.6%，p<0.001）。富含脂质斑块的患者斑块脱垂率（65.5%对49.1%，p<0.001）和纤维帽破裂率（65.5%对49.1%，p<0.001）显著更高。12例患者的ISR范围从无到42%；明显ISR的患者中贴壁不良的支架支柱和纤维帽破裂并不更常见。8例无明显再狭窄的患者仍有贴壁不良的支柱、嵌入的支柱、斑块脱垂和纤维帽破裂。
富含脂质斑块的患者在CAS后，支架支柱嵌入、斑块脱垂和纤维帽破裂更频繁，而良好贴壁的支架支柱更不频繁。
