Roleder Tomasz, Karimi Galougahi Keyvan, Chin Chee Yang, Bhatti Navdeep K, Brilakis Emmanouil, Nazif Tamim M, Kirtane Ajay J, Karmpaliotis Dimitri, Wojakowski Wojciech, Leon Martin B, Mintz Gary S, Maehara Akiko, Stone Gregg W, Ali Ziad A
Center for Interventional Vascular Therapy, Division of Cardiology, New York Presbyterian Hospital and Columbia University, New York, NY, USA.
Cardiovascular Research Foundation, New York, NY, USA.
Eur Heart J Cardiovasc Imaging. 2017 Jun 1;18(6):663-669. doi: 10.1093/ehjci/jew198.
Near-infrared spectroscopy (NIRS) has been employed to assess the composition of the atherosclerotic plaques in native coronary arteries. However, little is known about the detection of neoatherosclerosis by NIRS in in-stent restenosis (ISR). The aim of the study was to assess the relationship between the distribution of lipid determined by NIRS and morphology of ISR on optical coherence tomography (OCT).
We performed both NIRS and OCT in 39 drug-eluting stents with ISR. Values of lipid-core burden index (LCBI) derived by NIRS were compared with the OCT-derived thickness of the fibrous cap covering neoatherosclerotic lesions. A total of 22 (49%) in-stent neointimas were identified as lipid rich by both NIRS and OCT. There was good agreement between OCT and NIRS in identifying lipid within in-stent neointima (kappa = 0.60, 95% CI: 0.34-0.86). OCT identified thin-cap neoatheromas (TCNA) (<65 µm) in 12 stents (23%). The minimal cap thickness of in-stent neoatherosclerotic plaque measured by OCT correlated with the maxLCBI4mm (maximal LCBI per 4 mm) within the stent (r = -0.77, P< 0.01). Moreover, maxLCBI4mm was able to accurately predict TCNA with a cut-off value of >144.
NIRS correlates with OCT identification of lipids in stented vessels and is able to predict the presence of thin fibrous cap neoatheroma.
近红外光谱（NIRS）已被用于评估天然冠状动脉粥样硬化斑块的成分。然而，关于NIRS在支架内再狭窄（ISR）中检测新生动脉粥样硬化的情况知之甚少。本研究的目的是评估NIRS测定的脂质分布与光学相干断层扫描（OCT）上ISR形态之间的关系。
我们对39个发生ISR的药物洗脱支架进行了NIRS和OCT检查。将NIRS得出的脂质核心负荷指数（LCBI）值与OCT得出的覆盖新生动脉粥样硬化病变的纤维帽厚度进行比较。共有22个（49%）支架内新生内膜被NIRS和OCT均鉴定为富含脂质。在识别支架内新生内膜中的脂质方面，OCT和NIRS之间具有良好的一致性（kappa = 0.60，95%CI：0.34 - 0.86）。OCT在12个支架（23%）中识别出薄帽状新生动脉粥样硬化（TCNA）（<65 µm）。OCT测量的支架内新生动脉粥样硬化斑块的最小帽厚度与支架内的最大LCBI4mm（每4mm的最大LCBI）相关（r = -0.77，P<0.01）。此外，最大LCBI4mm能够以>144的临界值准确预测TCNA。
NIRS与OCT对支架血管内脂质的识别相关，并且能够预测薄纤维帽新生动脉粥样硬化的存在。
