Boeder Niklas F, Dörr Oliver, Bauer Timm, Elsässer Albrecht, Möllmann Helge, Achenbach Stephan, Hamm Christian W, Nef Holger M
University of Giessen, Department of Cardiology, Giessen, Germany.
Klinikum Oldenburg, Department of Cardiology, Oldenburg, Germany.
Cardiovasc Revasc Med. 2019 Jun;20(6):480-484. doi: 10.1016/j.carrev.2018.07.030. Epub 2018 Aug 2.
This study of patients treated with novolimus-eluting bioresorbable scaffold (BRS) investigated the impact of plaque burden on the acute mechanical performance of the BRS and the short-term outcome.
A total of 15 patients were enrolled. The following parameters were derived from optical coherence tomography (OCT) during the final pullback: mean and minimum area, residual area stenosis, incomplete strut apposition, tissue prolapse, scaffold expansion index (SEI), scaffold eccentricity index (SEC), symmetry index, strut fracture, and edge dissection. Fibrous plaque (FP) and calcific plaque (CP) characteristics were measured at each 200 μm longitudinal cross-section. The patients were divided into two groups based on their medians of the respective plaque characteristics.
OCT analysis showed a lumen area of 11.4 ± 1.9 mm and a scaffold area of 11.5 ± 2.1 mm. The mean eccentricity index overall was 0.65 ± 0.16 and mean symmetry index 0.39 ± 0.25. Statistically, scaffold expansion was not significantly influenced by a greater plaque burden as represented by greater CP area (SEI in group with CP area <0.52 mm 84.1% vs. SEI of 86.6% in group with CP area ≥0.52 mm, p = 0.06), thicker CP (85.7% vs. 85.1%, p = 0.06), greater CP arc angle (88.0% vs. 81.7%, p = 0.08), and CP being closer to the lumen (84.2% vs. 86.5%, p = 0.08). Scaffold expansion was also not significantly influenced by FP burden. The eccentricity of the implanted scaffolds was not dependent on the CP burden. On the other hand, a greater FP burden favoured a lower eccentricity index, indicating less circular expansion. Thus, greater FP area, FP thickness, and FP arc angle resulted in a more eccentric scaffold expansion.
In contrast to previously studied BRS, the expansion and eccentricity characteristics of the novolimus-eluting scaffold did not show the strong dependency of plaque composition, morphology, and burden. As assessed by OCT, only eccentricity was significantly affected by the FP burden. A greater FP plaque arc in our cohort and device-specific properties, e.g. self-correction, may explain the lack of a relationship between plaque, expansion, and eccentricity.
本研究对接受诺伐他汀洗脱生物可吸收支架（BRS）治疗的患者进行调查，以探究斑块负荷对BRS急性机械性能和短期预后的影响。
共纳入15例患者。在最终回撤过程中，通过光学相干断层扫描（OCT）得出以下参数：平均面积和最小面积、残余面积狭窄、支柱贴壁不全、组织脱垂、支架扩张指数（SEI）、支架偏心指数（SEC）、对称指数、支柱断裂和边缘夹层。在每200μm纵向横截面测量纤维斑块（FP）和钙化斑块（CP）特征。根据各自斑块特征的中位数将患者分为两组。
OCT分析显示管腔面积为11.4±1.9mm，支架面积为11.5±2.1mm。总体平均偏心指数为0.65±0.16，平均对称指数为0.39±0.25。从统计学角度来看，更大的斑块负荷（以更大的CP面积表示，CP面积<0.52mm组的SEI为84.1%，CP面积≥0.52mm组的SEI为86.6%，p=0.06）、更厚的CP（85.7%对85.1%，p=0.06）、更大的CP弧角（88.0%对81.7%，p=0.08）以及CP更靠近管腔（84.2%对86.5%，p=0.08），均未对支架扩张产生显著影响。支架扩张也未受到FP负荷的显著影响。植入支架的偏心度不依赖于CP负荷。另一方面，更大的FP负荷有利于降低偏心指数，表明扩张的圆形程度较低。因此，更大的FP面积、FP厚度和FP弧角导致支架扩张更偏心。
与先前研究的BRS不同，诺伐他汀洗脱支架的扩张和偏心特征并未显示出对斑块成分、形态和负荷的强烈依赖性。通过OCT评估，只有偏心度受到FP负荷的显著影响。在我们的队列中，更大的FP斑块弧以及特定器械属性（如自我校正）可能解释了斑块、扩张和偏心之间缺乏关联的原因。
