药物洗脱支架术后靶病变部位再发急性ST段抬高型心肌梗死的光学相干断层成像评价

发布时间：2018-04-12 23:12

本文选题：药物洗脱支架 + 靶病变部位　；参考：《中国老年学杂志》2017年04期

【摘要】：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。
[Abstract]:Objective to evaluate the imaging features of patients with recurrent acute ST-segment elevation myocardial infarction (STEMI) after coronary drug-eluting stenting by optical coherence tomography (Oct).Methods 15 patients with recurrent STEMI confirmed by coronary angiography (CAG) and drug-coated stents (des) were retrospectively analyzed.OCT was used to evaluate the imaging features of the target lesion of the culprit.Results among the 15 patients with recurrent STEMI after DES, 9 cases had anterior descending branch of the convict, 4 cases had right coronary artery stenosis, and 2 cases had circumflex branch.Imaging features of target lesion location: 4 cases of acute thrombosis in stents 3 cases of subacute thrombosis 5 cases of late thrombosis 3 cases of extremely late thrombosis. Oct showed 3 cases of stent marginal dissection 5 cases of bronchitisThere were 2 cases of dysmural adhesion (2 cases of positive vascular remodeling secondary acquired adhesion disorder 2 cases of incomplete lesion coverage 2 cases of new atherosclerotic plaque in stents) and 2 cases of stent endothelialization insufficiency (1 case) showed only thrombus formation.Conclusion Stemi Oct of stent edge dissection, poor adhesion, incomplete coverage and NAP rupture in stent can lead to the recurrence of STEMIOCT in these patients.
【作者单位】：河北医科大学第二医院心血管内科;
【分类号】：R542.22

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