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目的探讨光学相干断层成像技术(OCT)在急性心肌梗死斑块识别、经皮冠状动脉介入治疗(PCI)及随访中的应用价值。方法以2015年1月至2016年1月经冠状动脉(冠脉)造影证实的50例急性心肌梗死患者为研究对象,所有患者均接受OCT检查,评价冠脉斑块等病变情况,为PCI治疗提供指导。支架植入后马上行OCT检查,评价支架释放情况,同时术后3个月行OCT复查,评价随访情况。结果 50例患者OCT检查均成功获取清晰图像,共93支病变血管,无OCT相关并发症发生。OCT检出纤维斑块22处,脂质斑块35处,易损斑块28处。86支支架植入后OCT复查,显示支架扩张充分,支架与血管壁分离;2例急性ST段抬高型心肌梗死患者溶栓干预后造影复查显示正常,而OCT复查显示红色血栓、破溃斑块存在;50例患者支架内再狭窄2例,OCT检查显示为斑块破溃。PCI术后3个月OCT复查,无斑块形成,无明显不良心血管事件发生。结论 OCT在急性心肌梗死易损斑块识别、PCI干预及随访不良心血管事件判断中有重要作用。
Objective To investigate the value of optical coherence tomography (OCT) in identifying plaque in acute myocardial infarction, percutaneous coronary intervention (PCI) and follow-up. Methods Fifty patients with acute myocardial infarction confirmed by coronary (coronary) angiography from January 2015 to January 2016 were enrolled in this study. All patients underwent OCT to assess the lesion status such as coronary artery plaque. They were provided for PCI guide. Immediately after stent implantation OCT examination, evaluation of stent release, while 3 months after OCT review, evaluation of follow-up. Results Fifty patients underwent OCT examination to obtain clear images with a total of 93 vascular lesions without OCT related complications. OCT detected 22 fibrous plaques, 35 lipid plaques and 28 vulnerable plaques. OCT examination of 86 stents showed that the stents were well dilated and the stents were separated from the vessel wall. The angiographic findings of 2 patients with ST-segment elevation myocardial infarction were normal after thrombolysis intervention. The OCT showed red thrombus and ulceration spots There were 2 cases of in-stent restenosis in 50 patients, and the OCT showed plaque rupture. OCT 3 months after PCI review, no plaque formation, no significant adverse cardiovascular events. Conclusions OCT plays an important role in the identification of vulnerable plaques in acute myocardial infarction, PCI intervention and follow-up of adverse cardiovascular events.