Zhang Fei-Fei, Dang Yi, Hao Qing-Qing, Xie Yue-Tao, Li Shu-Ren, Qi Xiao-Yong
Department of Cardiology Center, Hebei General Hospital, Shijiazhuang, Hebei Province, China.
Medicine (Baltimore). 2018 Dec;97(50):e13669. doi: 10.1097/MD.0000000000013669.
Primary percutaneous coronary intervention (PPCI) with immediate stenting provides effective revascularization. While the risks of no-reflow, stent thrombosis, stent undersizing, and malapposition reduced the benefits in patients with high burden thrombosis. Intravascular imaging, especially optical coherence tomography (OCT), offers potential in optimization of percutaneous coronary intervention.
A 51-year-old male underwent coronary angiography (CAG) due to chest pain with minimal ST-segment depression of the electrocardiogram.
Urgent CAG revealed burden thrombus in the mid left anterior descending coronary artery (LAD) with TIMI grade I distal flow.
After aspiration thrombectomy, OCT was used to evaluate the target lesion of non-ST-segment elevation myocardial infarction (NSTEMI) and conservative treatment without stent implantation was selected.
CAG repeated 1 month after PPCI revealed TIMI grade III blood flow in LAD and only minimal stenosis in the target lesion. OCT showed a cavity formation due to plaque rupture and MLA increased after thrombus dissolution. Follow-up was uneventful at 6 months.
OCT may be useful imaging modality to identify the characteristic of culprit lesion of acute myocardial infarction and subsequently guide individual treatment.
直接支架植入的直接经皮冠状动脉介入治疗（PPCI）可提供有效的血运重建。然而，无复流、支架血栓形成、支架尺寸过小和贴壁不良的风险降低了高负荷血栓患者的获益。血管内成像，尤其是光学相干断层扫描（OCT），在优化经皮冠状动脉介入治疗方面具有潜力。
一名51岁男性因胸痛伴心电图ST段轻度压低接受冠状动脉造影（CAG）。
急诊CAG显示左前降支冠状动脉（LAD）中段有高负荷血栓，TIMI血流分级为I级。
在进行血栓抽吸术后，使用OCT评估非ST段抬高型心肌梗死（NSTEMI）的靶病变，并选择了不植入支架的保守治疗。
PPCI术后1个月重复进行CAG显示LAD的TIMI血流分级为III级，靶病变仅存在轻微狭窄。OCT显示由于斑块破裂形成了一个腔隙，血栓溶解后最小管腔面积（MLA）增加。6个月的随访无异常。
OCT可能是一种有用的成像方式，可用于识别急性心肌梗死罪犯病变的特征，进而指导个体化治疗。
