Xu Tian, You Wei, Wu Zhiming, Meng Peina, Ye Fei, Wu Xiangqi, Chen Shaoliang
Department of Cardiology, Nanjing First Hospital, Nanjing Medical University, 68 Changle Rd, Nanjing, 210006, China.
Sci Rep. 2022 Jan 11;12(1):534. doi: 10.1038/s41598-021-04579-9.
We used optical coherence tomography (OCT) to analyze the "half-moon" like phenomenon and its characteristics and observe 1-year follow-up of the in-stent restenosis (ISR) incidence after the drug eluted stent (DES) implantation in patients with the myocardial bridge (MB). Patients were retrospectively analyzed from January 2013 to December 2019. We used OCT to check 45 patients with MB and found a visible muscle layer (VML) around the vessel adventitia with the same or high density compared to the vessel media layer. There was not any significant difference in maximal thickness, maximal arch, and total length between the half-moon layer and the visible muscle layer groups (p > 0.05). Maximal thickness, arch, and total length of the half-moon layer were significantly positively related to VML, respectively (r = 0.962, 0.985, 0.742, p < 0.01). Of these 626 patients with MB seen by OCT, only 300 could be checked out by coronary angiography (CAG). Besides, the larger the thickness and arch of the VML around the vessel adventitia, the more severe the MB in these patients (p < 0.05). After the OCT use, there was no coronary perforation in these patients with MB covered with DES. After 1-year follow-up, ISR in MB covered with DES showed a notable difference among no MB, mild MB, moderate MB, and severe MB groups (p < 0.05), and ISR in DES aggravated with the MB severity. However, ISR in MB with and without covered with DES had no significant difference among the 4 groups (p > 0.05). OCT could evaluate MB characteristics accurately compared to IVUS and had a higher rate of detecting MB than CAG. Moreover, it is safe and effective to guide DES covering the mild MB segment in patients with severe coronary lesions detected by the OCT.
我们使用光学相干断层扫描（OCT）分析“半月形”现象及其特征，并观察心肌桥（MB）患者药物洗脱支架（DES）植入术后支架内再狭窄（ISR）发生率的1年随访情况。对2013年1月至2019年12月的患者进行回顾性分析。我们使用OCT检查了45例MB患者，发现血管外膜周围有一层可见肌层（VML），其密度与血管中膜层相同或更高。半月形层与可见肌层组之间在最大厚度、最大弓高和总长度方面无显著差异（p＞0.05）。半月形层的最大厚度、弓高和总长度分别与VML呈显著正相关（r = 0.962、0.985、0.742，p＜0.01）。在这626例经OCT检查的MB患者中，只有300例可通过冠状动脉造影（CAG）检查出来。此外，血管外膜周围VML的厚度和弓高越大，这些患者的MB越严重（p＜0.05）。在使用OCT后，这些接受DES覆盖的MB患者未发生冠状动脉穿孔。经过1年随访，DES覆盖的MB患者中，无MB、轻度MB、中度MB和重度MB组的ISR存在显著差异（p＜0.05），且DES中的ISR随MB严重程度加重。然而，DES覆盖和未覆盖的MB患者中，ISR在4组之间无显著差异（p＞0.05）。与血管内超声（IVUS）相比，OCT能更准确地评估MB特征且检测MB的比率高于CAG。此外，对于经OCT检测出的严重冠状动脉病变患者，指导DES覆盖轻度MB节段是安全有效的。
