Gatto Laura, Golino Marco, Marco Valeria, La Manna Alessio, Burzotta Francesco, Fineschi Massimo, Ruscica Giovanni, Di Giorgio Alessandro, Boi Alberto, Romagnoli Enrico, Albertucci Mario, Prati Francesco
Division of Cardiology, San Giovanni Addolorata Hospital.
C.L.I Foundation.
Coron Artery Dis. 2018 Aug;29(5):384-388. doi: 10.1097/MCA.0000000000000633.
Quantitative coronary angiography (QCA) is the gold standard for evaluating correct stenting, despite its limitation in recognizing features indicative of suboptimal deployment. This subanalysis of the CLI-OPCI II registry addressed the role of optical coherence tomography (OCT) to verify whether suboptimal OCT deployment occurs in the presence of an optimal angiographic result.
We retrospectively analyzed 125 lesions in the 105 patients with major adverse cardiac events of the CLI-OPCI II. Every lesion was evaluated with OCT and angiography, including visual and QCA assessment. Optimal angiographic result was defined as residual stenosis of less than 30% at QCA and absence of haziness at visual angiography. The following OCT features of suboptimal stenting were considered: edge dissection (linear rim of tissue with a width >200 μm), reference lumen narrowing (lumen area <4.5 mm in the presence of significant residual plaque adjacent to stent endings), and in-stent narrowing (minimum lumen area<4.5 mm).
Among the 125 lesions, 105 showed an optimal angiographic result. At OCT, a suboptimal positioning was common (56%). In the group of optimal angiographic results, OCT showed a suboptimal deployment in 54% of cases. Minimum lumen area of less than 4.5 mm, distal and proximal reference narrowing, and distal edge dissections were found in 30, 25, 15, and 7% of cases, respectively.
This substudy of the CLI-OPCI II showed that in patients with major adverse cardiac events, the presence of an optimal postintervention angiographic appearance with suboptimal OCT metrics is a frequent finding. Our data further support the effectiveness of OCT, which provide valuable information even in the presence of optimal poststenting angiographic results.
定量冠状动脉造影（QCA）是评估支架植入是否正确的金标准，尽管其在识别提示支架植入效果欠佳的特征方面存在局限性。CLI-OPCI II注册研究的这项亚分析探讨了光学相干断层扫描（OCT）在验证最佳血管造影结果存在时是否会出现欠佳的OCT支架植入情况方面的作用。
我们回顾性分析了CLI-OPCI II中105例发生主要不良心脏事件患者的125处病变。对每处病变均进行了OCT和血管造影评估，包括视觉评估和QCA评估。最佳血管造影结果定义为QCA时残余狭窄小于30%且视觉血管造影时无模糊。欠佳支架植入的以下OCT特征被纳入考虑：边缘夹层（宽度>200μm的组织线性边缘）、参考管腔狭窄（在支架末端相邻处存在显著残余斑块时管腔面积<4.5mm）和支架内狭窄（最小管腔面积<4.5mm）。
在125处病变中，105处显示出最佳血管造影结果。在OCT检查中，欠佳的定位很常见（56%）。在最佳血管造影结果组中，OCT显示54%的病例存在欠佳的支架植入情况。分别在30%、25%、15%和7%的病例中发现最小管腔面积小于4.5mm、远端和近端参考狭窄以及远端边缘夹层。
CLI-OPCI II的这项亚研究表明，在发生主要不良心脏事件的患者中，干预后血管造影外观最佳但OCT指标欠佳的情况很常见。我们的数据进一步支持了OCT的有效性，即使在支架植入后血管造影结果最佳的情况下，OCT也能提供有价值的信息。
