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目的应用冠状动脉血管内光学相干断层成像技术(optical coherence tomography,OCT)评价造影随访无再狭窄的药物洗脱支架(drug eluting stent,DES)内皮增生情况。方法从北京安贞医院2007年9月至2008年9月连续入选DES术后无症状而接受冠状动脉造影复查无明显再狭窄的患者18例,所有患者接受OCT检查,比较不同的DES植入时间、不同DES组之间,每组支架小梁血管内膜增生情况。结果共分析4709个支架小梁,其中被内皮完全覆盖的支架小梁个数4173个(88.6%),被内皮部分覆盖的个数是33个(0.7%),暴露的小梁个数382个(8.1%);贴壁不良的小梁个数121个(2.6%),覆盖支架小梁的内膜的平均厚度是0.099mm,内膜厚度>100μm的小梁个数2378个(50.5%);不同药物洗脱支架之间内膜增生厚度、支架小梁内膜覆盖及晚期支架贴壁不良差异有统计学意义;与DES植入时间<12个月相比,植入时间12个月血管内膜增生厚度有明显增加趋势(0.1183mm比0.0875mm;P=0.001);支架内膜无覆盖比率分别是:1.7%比6.8%(P<0.05);贴壁不良比率是:2.1%比0.5%(P<0.001)。结论通过OCT分析16个月左右的药物洗脱支架血管内膜厚度,总的来说90.1%的支架小梁有内膜覆盖,但是仍然有高达9.9%的无内膜覆盖,支架类型、支架置入时间之间内膜覆盖、支架贴壁有一定差异;同时支架植入大于12个月的支架贴壁不良比率高于不足12个月的,提示更晚期的支架贴壁不良情况存在,对于药物洗脱支架的随访时间应该更长,双联抗血小板治疗疗程也许应该更长。
Objective To evaluate the value of coronary angiography (OCT) in the evaluation of endothelium hyperplasia after drug-eluting stent (DES) with no-stenosis. Methods From September 2007 to September 2008 in Beijing Anzhen Hospital, patients with asymptomatic DES who underwent coronary angiography were retrospectively reviewed. There were 18 patients without obvious restenosis. All patients underwent OCT and compared with different DES implantation time , Different DES group, each group trabecular artery intimal hyperplasia. Results A total of 4,709 trabecular bends were analyzed, of which 4173 (88.6%) were covered by the endothelium, 33 (0.7%) were covered by the endothelium, and 382 trabeculae were exposed (8.1%). The number of adherent trabecular defects was 121 (2.6%). The average thickness of the intima covering the trabeculae was 0.099 mm. The number of trabeculae with the intima thickness of 100 μm was 2378 (50.5% ; The thickness of intimal hyperplasia between different drug-eluting stents, the stent trabecular inner membrane coverage and the poor adhesion of advanced stents were statistically significant; compared with DES implantation <12 months, the implantation time of 12 months The thickness of intimal hyperplasia was significantly increased (0.1183mm vs 0.0875mm; P = 0.001). The ratio of intima without stent was 1.7% vs 6.8% (P <0.05), and the rate of adherent dysplasia was 2.1% vs 0.5 % (P <0.001). Conclusions The intima-media thickness of drug-eluting stents at 16 months was analyzed by OCT. Overall, 90.1% of stents had intimal coverage, but nevertheless 9.9% were still free of endometrial coverage. Stent types, stent placement Into the time between the endometrial coverage, there are some differences in stent adherent; stent stenting more than 12 months stent adherent bad ratio higher than less than 12 months, suggesting that more advanced stent adherent problems exist, for drugs Follow-up of eluting stents should be longer and dual antiplatelet therapy may be longer.