Cuesta Javier, Rivero Fernando, Bastante Teresa, García-Guimaraes Marcos, Antuña Paula, Alvarado Teresa, Navarrete Gonzalo, Benedicto Amparo, Alfonso Fernando
Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain.
Servicio de Cardiología, Hospital Universitario de La Princesa, Madrid, Spain.
Rev Esp Cardiol (Engl Ed). 2017 Dec;70(12):1050-1058. doi: 10.1016/j.rec.2017.04.001. Epub 2017 May 9.
Stent thrombosis (ST) is a rare but potentially serious complication. Optical coherence tomography (OCT) provides high-resolution images and additional information to angiography in the study of this event.
Prospective study of patients with ST undergoing reintervention with OCT imaging.
The study included a total of 40 consecutive patients with ST. Mean age was 69 ± 13 years and 83% were male. Early ST (≤ 30 days) was observed in 16 patients and late ST (> 30 days) in 24 patients. Stent thrombosis occurred in 17 bare-metal stents and 23 drug-eluting stents. In 34 patients (85%), adequate OCT images were obtained at the time of the ST. The predominant mechanism in early ST was stent malapposition (39%). In late ST, high frequencies of uncovered (46%) and malapposed struts (17%) were observed, especially in patients with drug-eluting stents. Furthermore, the presence of neoatherosclerosis was very high (67%) in patients with late ST. After intervention, improvements were observed in malapposition length and the amount of residual thrombus.
OCT allows identification of the underlying mechanisms potentially involved in ST. This imaging modality is helpful in guiding reintervention in these patients, which improves the area and length of malapposition, as well as the maximal residual thrombus area.
支架血栓形成（ST）是一种罕见但可能严重的并发症。光学相干断层扫描（OCT）在该事件的研究中能提供高分辨率图像及血管造影之外的额外信息。
对接受OCT成像再干预的ST患者进行前瞻性研究。
该研究共纳入40例连续的ST患者。平均年龄为69±13岁，83%为男性。16例患者观察到早期ST（≤30天），24例患者观察到晚期ST（>30天）。17例裸金属支架和23例药物洗脱支架发生了支架血栓形成。34例患者（85%）在ST发生时获得了足够的OCT图像。早期ST的主要机制是支架贴壁不良（39%）。在晚期ST中，观察到较高频率的支架小梁未覆盖（46%）和贴壁不良（17%），尤其是在药物洗脱支架患者中。此外，晚期ST患者中新动脉粥样硬化的发生率非常高（67%）。干预后，支架贴壁不良长度和残余血栓量均有改善。
OCT能够识别可能与ST相关的潜在机制。这种成像方式有助于指导这些患者的再干预，可改善支架贴壁不良的面积和长度，以及最大残余血栓面积。
