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Title: [Optical coherence tomographic analysis of in-stent neoatherosclerosis in lesions with restenosis after drug-eluting stent implantation].
Author: Liu ZJ, Shi B, Deng CC, Xu GX, Zhao RZ, Shen CY, Wang ZL, Liu HL.
Journal: Zhonghua Xin Xue Guan Bing Za Zhi; 2018 Jan 24; 46(1):44-49. PubMed ID: 29374937.
Abstract:
Objective: To explore the imaging characteristics and related influencing factors of in-stent neoatherosclerosis (ISNA) in patients with restenosis after drug-eluting stent(DES) implantation with optical coherence tomography(OCT). Methods: A total of 25 cases of coronary heart disease patients(DES placement time ≥8 months) with coronary artery angiography showing DES in-stent restenosis (ISR) in Zunyi medical college affiliated hospital from July 2013 to December 2015 were included in this study and patient's data were retrospectively analyzed.In these patients with ISR, OCT images were acquired before percutaneous coronary intervention. Patients were divided into the ISNA group (12 patients and 12 lesions) and non-ISNA group(13 patients and 13 lesions) according to the result of OCT. ISNA on OCT was defined as neointima formation with the presence of lipids or calcification. Results: (1) The incidence of chronic kidney disease and increased low-density lipoprotein cholesterol level in ISNA group were significant higher than that in non-ISNA group(all P<0.05). The stent implantation time in ISNA group was longer than that in the non-ISNA group(53.0(14.0, 81.0) months vs. 15.0(8.5, 32.5) months, P<0.01). In addition, clinical manifestation of acute coronary syndrome was present in 8 out of 12 patientsin ISNA group, and stable angina pectoris was found in 10 out of 13 casesin non-ISNA group(P<0.01). (2) Quantitative analysis of OCT showed that the lumen area was less in ISNA group than in non-ISNA group((3.45±1.82)mm(2) vs. (4.17±1.68)mm(2), P<0.01), and neointimal area(3.89(2.26, 5.52)mm(2) vs. 2.96(1.99, 4.22)mm(2), P<0.01), neointimal load (53.15(40.18, 67.30)% vs. 41.54(32.08, 56.91)%, P<0.01), neointimal thickness(0.98(0.63, 1.36)μm vs. 0.72(0.51, 1.03)μm, P<0.01) were higher in ISNA group than in non-ISNA group.(3)Qualitative analysis of OCT showed that the prevalence of homogeneous intima was less in the ISNA group than in the non-ISNA group ((41.42±22.56)% vs.(72.06±18.68)%, P<0.05), on the contrary, the heterogeneous intima was more common in the ISNA group ((58.57±22.56)% vs. (27.94±18.68)%, P<0.05). There was no significant difference between two groups in the peri-stentmicrovessels (9/12 vs. 5/13,P>0.05), and prevalence of intraintimalmicrovessels was higher in the ISNA group than in non-ISNA group (7/12 vs. 2/13, P<0.05). In addition, thin cap fibrous plaque(7/12 vs. 0, P<0.01), disrupted intima with visible cavity (7/12 vs. 1/13, P<0.05),andintraluminal red thrombus(7/12 vs. 1/13, P<0.05) were significantly higher in ISNA group than in non-ISNA group. Conclusions: Results of OCT show that ISNA occurs frequently in patients with ISR after DES implantation. The stent implantation time, incidence of chronic kidney disease and higher low-density lipoprotein cholesterol level are associated with the formation of ISNA in these patients. 目的： 探讨药物洗脱支架（DES）置入术后再狭窄病变处支架内新生动脉粥样硬化斑块（ISNA）的光学相干断层成像（OCT）影像学表现及其影响因素。 方法： 入选2013年7月至2015年12月在遵义医学院附属医院行冠状动脉造影显示DES置入后发生支架内再狭窄的冠心病患者25例（DES置入时间≥8个月），对其临床资料进行回顾性分析。介入治疗前于靶病变处行OCT检查，根据OCT结果将患者分为非ISNA组（13例患者，共13处病变）和ISNA组（12例患者，共12处病变）。ISNA定义为OCT图像上可见支架内新生内膜形成且富含脂质或钙化。 结果： （1）ISNA组慢性肾脏病患病率和低密度脂蛋白胆固醇水平均高于非ISNA组（P均<0.05）。ISNA组置入支架时间长于非ISNA组[53.0（14.0, 81.0）个月比15.0（8.5, 32.5）个月，P<0.01]。ISNA组患者临床表现为急性冠状动脉综合征的比例为8/12，非ISNA组患者临床表现为稳定性心绞痛的比例为10/13，差异有统计学意义（P<0.01）。（2）OCT定量分析显示，ISNA组管腔面积小于非ISNA组[（3.45±1.82）mm(2)比（4.17±1.68）mm(2), P<0.01]，新生内膜面积[3.89（2.26, 5.52）mm(2)比2.96（1.99, 4.22）mm(2), P<0.01]、新生内膜负荷[53.15（40.18, 67.30）%比41.54（32.08, 56.91）%, P<0.01]和新生内膜厚度[0.98（0.63, 1.36）μm比0.72（0.51, 1.03）μm, P<0.01]均大于非ISNA组。（3）OCT定性分析显示，ISNA组均质性内膜比率低于非ISNA组[（41.42±22.56）%比（72.06±18.68）%, P<0.05]，而异质性内膜比率高于ISNA组[（58.57±22.56）%比（27.94±18.68）%, P<0.05]；支架周围微血管比例两组之间差异无统计学意义（9/12比5/13,P>0.05），而内膜内微血管比例ISNA组高于非ISNA组（7/12比2/13, P<0.05）；ISNA组薄帽纤维粥样斑块（7/12比0, P<0.01）、带腔内膜破裂（7/12比1/13, P<0.05）和管腔内红色血栓（7/12比1/13, P<0.05）比例高于非ISNA组。 结论： OCT检查表明ISNA在DES置入术后的再狭窄病变中较常见；置入支架时间、慢性肾脏病患病率和低密度脂蛋白胆固醇水平可能与ISNA形成有关。.

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