中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2012年
9期
747-751
,共5页
王天杰%杨跃进%徐波%许亮%孙中伟%马超%唐跃%田毅%袁卫民%褚雁
王天傑%楊躍進%徐波%許亮%孫中偉%馬超%唐躍%田毅%袁衛民%褚雁
왕천걸%양약진%서파%허량%손중위%마초%당약%전의%원위민%저안
药物洗脱支架%体层摄影术,光学相干%新生内膜
藥物洗脫支架%體層攝影術,光學相榦%新生內膜
약물세탈지가%체층섭영술,광학상간%신생내막
Drug-eluting stents%Tomography,optical coherence%Neointima
目的 应用光学相干断层成像(OCT)评价药物洗脱支架置入术后极早期新生内膜的覆盖情况.方法 入选行药物洗脱支架置入术的冠心病患者12例.支架释放后即刻和术后1周左右进行OCT检查,评价药物洗脱支架置入术后极早期新生内膜的覆盖情况.同时选取健康中华小型猪5只,置入雷帕霉素洗脱支架,1周后进行OCT和病理学检查.结果 (1)12例患者共置入29枚药物洗脱支架,支架术后(7.7±2.6)d复查OCT.患者均未发生严重心血管不良事件.OCT检查显示大部分支架丝处于裸露状态,支架内膜覆盖率为(21.8±17.7)％,新生内膜厚度为(42.9±32.2)μm,贴壁不良率为(1.5±3.0)％,2例患者存在支架内附壁血栓(发生率为16.7％).(2)在中华小型猪模型中,支架术后1周OCT检测的新生内膜覆盖率为(43.2±11.5)％,新生内膜厚度为(24.0±8.5)μm；病理学检查发现早期覆盖于支架上的组织主要包括蛋白聚糖、炎症细胞、纤维素和机化血栓,仅部分内膜有少量内皮细胞覆盖.结论 OCT检查显示药物洗脱支架置人1周后即有新生内膜覆盖,但覆盖率较低,且新生内膜成分以蛋白聚糖、炎症细胞和机化血栓为主,再内皮化情况较差.
目的 應用光學相榦斷層成像(OCT)評價藥物洗脫支架置入術後極早期新生內膜的覆蓋情況.方法 入選行藥物洗脫支架置入術的冠心病患者12例.支架釋放後即刻和術後1週左右進行OCT檢查,評價藥物洗脫支架置入術後極早期新生內膜的覆蓋情況.同時選取健康中華小型豬5隻,置入雷帕黴素洗脫支架,1週後進行OCT和病理學檢查.結果 (1)12例患者共置入29枚藥物洗脫支架,支架術後(7.7±2.6)d複查OCT.患者均未髮生嚴重心血管不良事件.OCT檢查顯示大部分支架絲處于裸露狀態,支架內膜覆蓋率為(21.8±17.7)％,新生內膜厚度為(42.9±32.2)μm,貼壁不良率為(1.5±3.0)％,2例患者存在支架內附壁血栓(髮生率為16.7％).(2)在中華小型豬模型中,支架術後1週OCT檢測的新生內膜覆蓋率為(43.2±11.5)％,新生內膜厚度為(24.0±8.5)μm；病理學檢查髮現早期覆蓋于支架上的組織主要包括蛋白聚糖、炎癥細胞、纖維素和機化血栓,僅部分內膜有少量內皮細胞覆蓋.結論 OCT檢查顯示藥物洗脫支架置人1週後即有新生內膜覆蓋,但覆蓋率較低,且新生內膜成分以蛋白聚糖、炎癥細胞和機化血栓為主,再內皮化情況較差.
목적 응용광학상간단층성상(OCT)평개약물세탈지가치입술후겁조기신생내막적복개정황.방법 입선행약물세탈지가치입술적관심병환자12례.지가석방후즉각화술후1주좌우진행OCT검사,평개약물세탈지가치입술후겁조기신생내막적복개정황.동시선취건강중화소형저5지,치입뢰파매소세탈지가,1주후진행OCT화병이학검사.결과 (1)12례환자공치입29매약물세탈지가,지가술후(7.7±2.6)d복사OCT.환자균미발생엄중심혈관불량사건.OCT검사현시대부분지가사처우라로상태,지가내막복개솔위(21.8±17.7)％,신생내막후도위(42.9±32.2)μm,첩벽불량솔위(1.5±3.0)％,2례환자존재지가내부벽혈전(발생솔위16.7％).(2)재중화소형저모형중,지가술후1주OCT검측적신생내막복개솔위(43.2±11.5)％,신생내막후도위(24.0±8.5)μm；병이학검사발현조기복개우지가상적조직주요포괄단백취당、염증세포、섬유소화궤화혈전,부부분내막유소량내피세포복개.결론 OCT검사현시약물세탈지가치인1주후즉유신생내막복개,단복개솔교저,차신생내막성분이단백취당、염증세포화궤화혈전위주,재내피화정황교차.
Objective To investigate the neointimal coverage at the very early phase after drugeluting stent (DES) implantation using optical coherence tomography (OCT).Methods OCT examination was performed immediately after stent deployment and about one week post stenting in 12 patients with coronary artery disease to detect neointimal coverage and stent thrombus.Sirolimus eluting stent implantation was also performed in 5 healthy Chinese minipigs,OCT and histopathology examination were made one week later in these minipigs.Results ( 1 ) Twenty-nine DES were implanted in 12 patients.There was no major cardiovascular event post stenting.The mean time of follow-up was ( 7.7± 2.6)d,the mean percentage of stent coverage was (21.8±17.7)％,and neointimal hyperplasia thickness was (42.9 ±32.2 ) μm and the percentage of malapposition struts was ( 1.5 ± 3.0) ％,respectively.Mural stent thrombus was found in 2 of the 12 patients (the percentage is 16.7％ ).(2) In the minipigs model,OCT evidenced that (43.2±11.5 ) ％ struts were covered by neointima with a mean neointimal hyperplasia thickness of ( 24.0 ± 8.5 ) μm at one week.Histopathology examination illustrated that the neointima was mainly consisted of proteoglycan,inflammation cells,fibrin and organized thrombus at the very early phase after DES implantation,while endothelial cells were barely found on the neointima.Conclusions Neointimal coverage is found as early as one week after DES implantation by OCT.The covered struts rate is very low and the main components of neointima are proteoglycan,inflammation cells,fibrin and organized thrombus.Re-endothelialization is rather poor at the very early phase post DES implantation.
