Zhang Fei-Fan, Thapa Manishwor, Zou Hao-Yu, Yao Jin-Biao, Chen Ping-Bo, Wu Pei, Ji Zhi-Yong, Xu Shan-Cai, Wang Xin, Shi Huai-Zhang, Wang Chun-Lei
Department of Neurosurgery, The First Affiliated Hospital of Harbin Medical University, Harbin, China.
Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Quant Imaging Med Surg. 2025 Jun 6;15(6):5520-5533. doi: 10.21037/qims-2024-2487. Epub 2025 Jun 3.
Intracranial vertebral artery stenosis is a significant cause of ischemic stroke. Intravascular optical coherence tomography (OCT), known for its high resolution, can accurately analyze the microstructure components of the stenotic vessel wall. Although widely used in the cardiovascular system, its application in intracranial atherosclerotic diseases of intracranial arteries remains limited. This study aimed to utilize OCT as a novel imaging modality for vessel wall microstructure analysis in patients with intracranial atherosclerosis. Specifically, it analyzed the vascular walls of 15 patients with severe intracranial vertebrobasilar artery stenosis before and after endovascular stent treatment.
A retrospective analysis was conducted from 7 March 2023 to 26 March 2024 at The First Affiliated Hospital of Harbin Medical University, focusing on the neurosurgical endovascular stent treatment and OCT evaluation of 15 cases of intracranial vertebrobasilar artery stenosis (70-90%). All lesions were located in the V4 segment of the vertebral artery.
OCT accurately identified the vessel wall microstructures in patients with intracranial vertebrobasilar artery stenosis before and after endovascular stent treatment. Identified structures included fibrous plaques, lipid plaques, calcified plaques, ruptured plaques, intraluminal thrombosis, vascular dissection, microchannels, macrophages, cholesterol crystals, healing plaques, tissue prolapse, stent thrombosis, and stent adherence. Following endovascular stent treatment and OCT only one patient experienced symptomatic complications.
The evaluation of intracranial vertebrobasilar arteries using OCT was shown to be safe and feasible. This technique aids in the diagnosis and treatment of cerebrovascular diseases. However, this preliminary study should be validated through prospective large-scale studies.
颅内椎动脉狭窄是缺血性卒中的重要病因。血管内光学相干断层扫描（OCT）以其高分辨率著称，能够准确分析狭窄血管壁的微观结构成分。尽管其在心血管系统中广泛应用，但其在颅内动脉粥样硬化疾病中的应用仍然有限。本研究旨在将OCT作为一种新型成像方式，用于颅内动脉粥样硬化患者血管壁微观结构分析。具体而言，分析了15例严重颅内椎基底动脉狭窄患者在血管内支架治疗前后的血管壁情况。
于2023年3月7日至2024年3月26日在哈尔滨医科大学附属第一医院进行回顾性分析，重点关注15例颅内椎基底动脉狭窄（70%-90%）患者的神经外科血管内支架治疗及OCT评估。所有病变均位于椎动脉V4段。
OCT准确识别了颅内椎基底动脉狭窄患者在血管内支架治疗前后的血管壁微观结构。识别出的结构包括纤维斑块、脂质斑块、钙化斑块、破裂斑块、管腔内血栓形成、血管夹层、微通道、巨噬细胞、胆固醇结晶、愈合斑块、组织脱垂、支架内血栓形成和支架贴壁。血管内支架治疗及OCT检查后，仅有1例患者出现症状性并发症。
使用OCT评估颅内椎基底动脉显示是安全可行的。该技术有助于脑血管疾病的诊断和治疗。然而，这项初步研究应通过前瞻性大规模研究进行验证。
