Webb Carolyn M, Orion Eyal, Taggart David P, Channon Keith M, Di Mario Carlo
Department of Cardiology, National Institute of Health Research Cardiovascular BRU, Royal Brompton Hospital, and the National Heart & Lung Institute, Imperial College London, London, UK
Vascular Graft Solutions, Tel Aviv, Israel.
Eur Heart J Cardiovasc Imaging. 2016 Nov;17(11):1290-1295. doi: 10.1093/ehjci/jev310. Epub 2015 Nov 30.
The Venous External Support Trial (VEST) evaluated whether a novel external stent attenuated saphenous vein graft (SVG) disease assessed with intravascular ultrasound 1 year following coronary artery bypass graft (CABG) surgery. This sub-study assessed SVGs with and without external stenting using optical coherence tomography (OCT). The aim of this study was to accurately compare quantitative and qualitative features of SVGs with and without a novel external stent using OCT.
Twenty-four of 30 patients (65 ± 8 years) enrolled in VEST underwent coronary angiography with OCT imaging using a non-occlusive technique. Quantitative analysis of lumen area was performed in one frame every 10 mm along the length of the graft, from distal to proximal anastomosis, and pathological features within the lumen were noted. Mean cross-sectional area was greater in unstented vs. stented grafts (8.4 ± 3 vs. 7.6 ± 2.7 mm; P = 0.005). The lumen of the stented grafts was more homogeneous (difference between maximum and minimum lumen diameter was significantly smaller in stented compared with unstented grafts, 0.28 ± 0.19 vs. 0.33 ± 0.23 mm, respectively, P = 0.006), and more circular (mean eccentricity index 0.08 ± 0.06 vs. 0.10 ± 0.06, stented vs. unstented; P = 0.019). Adherent thrombus was identified in three grafts (all unstented).
Our findings highlight the early changes occurring in SVGs after implantation of aorto-coronary bypass conduits, changes that may accelerate vein graft failure. External stenting resulted in a more homogeneous and less eccentric lumen with no thrombus formation.
静脉外支撑试验（VEST）评估了一种新型外部支架是否能减轻冠状动脉旁路移植术（CABG）后1年通过血管内超声评估的大隐静脉移植物（SVG）病变。这项子研究使用光学相干断层扫描（OCT）评估了有和没有外部支架的SVG。本研究的目的是使用OCT准确比较有和没有新型外部支架的SVG的定量和定性特征。
VEST研究中纳入的30例患者（65±8岁）中的24例接受了使用非闭塞技术的冠状动脉造影和OCT成像。沿着移植物长度，从远端到近端吻合口，每10 mm的一帧中进行管腔面积的定量分析，并记录管腔内的病理特征。无支架移植物的平均横截面积大于有支架移植物（8.4±3 vs. 7.6±2.7 mm²；P = 0.005）。有支架移植物的管腔更均匀（有支架移植物的最大和最小管腔直径之间的差异明显小于无支架移植物，分别为0.28±0.19 vs. 0.33±0.23 mm，P = 0.006），并且更呈圆形（平均偏心指数0.08±0.06 vs. 0.10±0.06，有支架与无支架；P = 0.019）。在三个移植物（均无支架）中发现了附着血栓。
我们的研究结果突出了主动脉-冠状动脉旁路移植术后SVG中发生的早期变化，这些变化可能加速静脉移植物失败。外部支架导致管腔更均匀且偏心性更小，且无血栓形成。
