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目的应用光学相干断层成像(OCT)评价冠脉药物洗脱支架术后靶病变部位再发急性ST段抬高型心肌梗死(STEMI)患者的影像特征。方法回顾性分析行药物涂层支架(DES)植入,冠脉造影(CAG)证实靶病变部位再发STEMI的15例患者。应用OCT评价罪犯血管靶病变部位影像特点。结果 15例DES术后再发STEMI患者中,罪犯血管前降支(LAD)9例,右冠脉(RCA)4例,回旋支(LCX)2例。靶病变部位影像特征:CAG均表现为支架内血栓形成,4例急性血栓形成,3例亚急性血栓形成,5例晚期血栓形成,3例极晚期血栓形成。OCT表现为3例支架边缘夹层;5例支架贴壁不良(其中2例正性血管重构继发获得性贴壁不良);2例病变覆盖不全;2例支架内新生粥样硬化斑块(NAP)形成伴破裂;2例支架内皮化不全;1例表现仅为血栓形成。结论支架边缘夹层、贴壁不良、覆盖不全以及支架内NAP破裂均可导致支架术后靶病变部位再发STEMI,OCT对该类患者治疗有指导意义。
Objective To evaluate the imaging features of patients with acute ST-segment elevation myocardial infarction (STEMI) after coronary stent implantation by using optical coherence tomography (OCT). Methods Fifteen patients with STEMI confirmed by targeted coronary angiography (CAG) underwent stent implantation (DES) were retrospectively analyzed. Using OCT to evaluate the characteristics of the target lesion in the target of criminals. Results Among the 15 STEMI patients who underwent DES, there were 9 cases of anterior descending coronary artery (LAD), 4 cases of right coronary artery (RCA) and 2 cases of LCX. Target lesion site imaging features: CAG showed stent thrombosis, 4 cases of acute thrombosis, 3 cases of subacute thrombosis, 5 cases of advanced thrombosis, 3 cases of very advanced thrombosis. OCT showed 3 cases of stent edge dissection; 5 cases of poor adherent stent (2 cases of positive vascular remodeling secondary acquired adherent dysplasia); 2 cases of incomplete coverage; 2 cases of stent neointimal atherosclerosis NAP) formed with rupture; 2 cases of stent endothelialization; 1 case showed only thrombosis. Conclusions Stent marginal dissection, poor adhesion, incomplete coverage, and NAP rupture in the scaffolds may lead to the recurrence of the target lesion after stenting, and OCT may be of guiding significance for the treatment of these patients.