血管内光学相干断层成像在颈动脉粥样硬化患者的诊断及介入治疗中的应用研究
发布时间：2018-09-19 13:11
【摘要】：第一部分频域光学相干断层成像(FD-OCT)技术在颈动脉斑块评估及颈动脉支架术中应用的安全性及可行性研究背景和目的:本研究通过探讨FD-OCT技术在颈动脉系统中的应用,分析了其在颈动脉斑块评估及颈动脉支架术中应用的安全性和可行性。对象与方法:本研究纳入2014年1月至2015年5月在南京军区南京总医院神经内科行颈动脉血管成像检查,确认为颈动脉粥样硬化并行OCT检查及颈动脉支架置入术患者。每名患者的OCT图像分别在CAS术前及术后获取两次。获取时采用100%造影剂,速度8ml/s,总量15ml。两名研究人员分别对所获取的图像进行评分,评分为1-10分。采用Cohen’s统计分析对观察者之间和观察者内部的可靠性进行分析,以P0.05为差异有统计学意义。结果:本研究共纳入22名患者,进行了44次扫描,成功获取了40/44(90.9%)的合格图像。在OCT操作过程中未出现手术相关的神经系统并发症(0%)。OCT所获取的图像质量较高(平均7.5±0.9分)。在CAS术后,OCT图像可以发现明确的纤维帽破损、支架贴壁不良及斑块脱垂。在OCT图像评分识别中,观察者内及观察者间的有较高的一致性(κ=0.76 andκ=0.82,respectively;both p0.001)。结论:本研究为OCT技术在国内首次应用于颈动脉系统。研究证实了OCT技术在颈动脉系统中应用的安全性及可行性。OCT可以为颈动脉斑块的评估,颈动脉支架置入术的术后评估提供更为丰富的资料。第二部分症状性颈动脉粥样硬化与无症状性颈动脉粥样硬化OCT检查的结果比较背景与目的:对于无症状性颈动脉粥样硬化患者,斑块性质的判定和评估非常必要。本研究通过OCT技术,比较症状性和非症状性颈动脉粥样硬化斑块的形态学特点,为OCT技术在颈动脉系统中的应用提供依据。对象与方法:研究纳入2014年1月至2015年5月在南京军区南京总医院神经内科行颈动脉血管成像检查,经有无创检查确诊为颈动脉粥样硬化,并行OCT检查的患者。根据患者就诊前6个月内症状的有无,将患者分为两组,即有症状组和无症状组。通过DSA及OCT确定患者病变血管的狭窄程度,记录OCT图像观察到的斑块特征,并进行比较。两组间的计数资料采用χ2检验或Fisher检验。应用Cohen’s统计分析对观察者之间和观察者内部的可靠性进行分析。采用二分类Logistic回归对症状发生的独立危险因素进行分析。采用Bland-Altman plot检验对OCT和DSA所测得的血管直径狭窄程度的一致性进行检验。结果:共有52例病人完成OCT检查。DSA检查与OCT检查技术在颈动脉直径测量上有着良好的一致性和相关性。症状性患者的VI型斑块发生率较高(68.0%vs.33.3%,respectively;p=0.025),巨噬细胞浸润的发生率高(52.0%vs.22.2%,p=0.043),附壁血栓的发生率高(64.0%vs.37.0%,p=0.095),纤维化斑块的发生率较低(40.0%vs.70.4%,respectively;p=0.050)。通过logistic回归分析提示,VI型斑块(OR:13.798,95%CI:1.38 to 137.675,p=0.025)与巨噬细胞浸润(OR:5.856,95%CI:1.405 to24.406,p=0.015)是颈动脉狭窄患者症状发生的独立危险因素。结论:OCT技术可对颈动脉狭窄患者的血管狭窄程度进行分析。症状性颈动脉狭窄患者的复杂型斑块发生率较非症状性患者高。VI型斑块、巨噬细胞浸润是颈动脉狭窄患者症状发生的独立危险因素;第三部分颈动脉粥样硬化脂质斑块对颈动脉支架贴壁情况的影响——基于OCT的观察研究背景与目的:颈动脉支架目前已成为治疗颅外颈动脉狭窄的主要方法之一。在行CAS的过程中,支架贴壁情况、斑块脱垂以及纤维帽破损等情况多有发生。本研究通过分析CAS术后支架贴壁情况与脂质斑块之间的关系,继而进一步探讨支架贴壁不良、斑块脱垂及纤维帽破损等CAS术后情况对支架内再狭窄的影响。对象与方法:研究连续纳入2014年4月至2015年5月在南京军区南京总医院神经内科行颈动脉血管成像检查,确认为颈动脉粥样硬化并行OCT检查及CAS术的患者。所取图像中的支架贴壁不良、斑块脱垂及纤维膜破损等支架与斑块之间的关系均被记录。支架贴壁情况以所分析的支撑杆贴壁情况所占图像支撑杆总数的百分比表示。同时记录观察到的支架贴壁不良、斑块脱垂、纤维帽破损等图像的具体层数。采用χ2检验、Fisher检验或one-way ANOVA对两组间的计数资料进行比较。采用Kruskal-Wallis检验对两组间纤维帽厚度的进行比较。采用Cohen’s统计分析对观察者之间和观察者内部的可靠性进行分析。以P0.05为差异有统计学意义。结果:本研究共纳入26名患者,其中20名患者获取质量合格图像,6名患者由于OCT图像质量不合格,予以排除。脂质斑块的支撑杆贴壁不良率为16.0%,非脂质斑块的支撑杆贴壁不良率为16.7%(p=0.953)。脂质斑块组支撑杆内陷率为29.4%,非脂质斑块支撑杆内陷率为23.7%(p0.001)。脂质斑块组支撑杆贴壁良好率为54.6%,非脂质斑块组支撑杆贴壁良好率为59.6%(p0.001)。脂质斑块组斑块脱垂率为65.5%,非脂质斑块组斑块脱垂率为49.1%(p0.001)。二组间纤维帽破损率也有明显差异,脂质斑块组为49.8%,非脂质斑块组为33.7%(p0.001)。二组间支架贴壁不良率无明显差异,脂质斑块组为12.3%,非脂质斑块组为14.9%(p=0.489)。支架贴壁不良、支架内陷、斑块脱垂及纤维帽破损患者在6个月随访时,未发现明显的支架内再狭窄。结论:脂质斑块组与非脂质斑块组之间的支架贴壁不良率之间无显著差异。而非脂质斑块组患者的斑块脱垂、纤维帽破损等情况发生较低。在本研究中,6个月随访时,支架贴壁不良、纤维帽破裂患者的支架内再狭窄发生率未见明显升高。第四部分应用OCT观察到颈动脉支架术后支架内急性血栓形成1例并文献复习支架内急性血栓形成是较为少见的颈动脉支架并发症。但是该并发症若处理不及时,则会导致血管闭塞,神经功能缺损,甚至影响手术效果,威胁生命。OCT可以在颈动脉支架术前、术中及术后对颈动脉病变情况、颈动脉支架与管壁之间的关系以及支架内急性血栓的形成进行观察和记录。本研究通过1例病例报道,证实OCT能够对支架内急性血栓的形成进行直观的记录和描述。第五部分血管内光学相干断层成像系统在脑血管介入治疗中的评估术语、方法及临床应用综述OCT作为一种使用近红外光的新的血管内成像方法,图像分辨率相对于普通血管内超声检查(IVUS)而言所具有的明显优势。OCT可以为颈内动脉动脉血管壁进行更为详尽的分析,提供更多的信息,其中包括对斑块性质的评估、对不稳定斑块的鉴别以及对颈动脉狭窄介入相关的血管反应。该部分主要综述介绍了OCT在脑血管介入治疗中的评估术语、评估方法及临床应用现状以及未来非发展展望。
[Abstract]:Part I: The safety and feasibility of frequency domain optical coherence tomography (FD-OCT) in carotid plaque assessment and carotid artery stenting. Background and purpose: This study analyzed the safety of FD-OCT in carotid plaque assessment and carotid artery stenting by exploring the application of FD-OCT in carotid artery system. Objectives and Methods: From January 2014 to May 2015, carotid angiography was performed in the Department of Neurology, Nanjing General Hospital of Nanjing Military Region, Nanjing Military Region. The two researchers scored 1-10 points on the images respectively. Cohen's statistical analysis was used to analyze the reliability between the observers and within the observers. The difference was statistically significant (P 0.05). Results: A total of 22 patients were included in the study and 44 scans were performed. 40/44 (90.9%) of the eligible images were obtained successfully. There were no surgical-related neurological complications (0%) during OCT. The quality of the images obtained by OCT was high (mean 7.5.9 points). After CAS, clear fibrous cap damage, poor stent attachment and plaque prolapse could be found in the OCT images. Conclusion: This study is the first application of OCT in carotid artery system in China. The study confirms the safety and feasibility of OCT in carotid artery system. OCT can be used to evaluate carotid plaque and carotid artery stenting. The second part is the comparison of the results of symptomatic carotid atherosclerosis and asymptomatic carotid atherosclerosis OCT. Background and purpose: For asymptomatic carotid atherosclerosis patients, it is necessary to determine and assess the nature of the plaque. The morphological characteristics of carotid atherosclerotic plaques provide the basis for the application of OCT in carotid artery system. Objectives and Methods: The study included carotid angiography in the Department of Neurology, Nanjing General Hospital of Nanjing Military Region from January 2014 to May 2015. The patients were diagnosed as carotid atherosclerosis by invasive examination and OCT examination. Patients were divided into two groups according to the symptoms within 6 months before treatment: symptomatic group and asymptomatic group. The degree of stenosis of the lesion vessels was determined by DSA and OCT, and the plaque features observed by OCT images were recorded and compared. The counting data between the two groups were analyzed by_2 test or Fisher test. Cohen's statistical analysis was used. The reliability between observers and within observers was analyzed. The independent risk factors for symptoms were analyzed by binary logistic regression. The consistency of the degree of stenosis of vessel diameter measured by OCT and DSA was examined by Bland-Altman plot test. Results: A total of 52 patients completed OCT, DSA and OCT. Symptomatic patients had higher incidence of VI plaque (68.0% vs. 33.3%, respectively; P = 0.025), higher incidence of macrophage infiltration (52.0% vs. 22.2%, P = 0.043), higher incidence of mural thrombosis (64.0% vs. 37.0%, P = 0.095), and lower incidence of fibrotic plaque (40.0.0% vs. 22.2%, P = 0.043). Logistic regression analysis showed that VI plaque (OR: 13.798, 95% CI: 1.38 to 137.675, P = 0.025) and macrophage infiltration (OR: 5.856, 95% CI: 1.405 to 24.406, P = 0.015) were independent risk factors for carotid stenosis. The incidence of complex plaques in symptomatic carotid stenosis was higher than that in asymptomatic carotid stenosis patients. VI plaque and macrophage infiltration were independent risk factors for carotid stenosis symptoms. Part III Effects of carotid atherosclerotic lipid plaque on carotid stent adherence: An OCT-based study BACKGROUND AND OBJECTIVE: Carotid artery stent has become one of the main methods for the treatment of extracranial carotid artery stenosis. During CAS, stent adherence, plaque prolapse and fibrous cap damage often occur. This study analyzed the relationship between stent adherence and lipid plaque after CAS, and then further explored the branches. Objectives and Methods: Carotid artery angiography was performed in the Department of Neurology, Nanjing General Hospital of Nanjing Military Region from April 2014 to May 2015. The patients were identified as carotid atherosclerosis with OCT and CAS. The relationship between the scaffold and the plaque was recorded in the images. The scaffold adherence was expressed as a percentage of the total number of the scaffolds. The specific layers of the scaffolds were also recorded, such as poor adherence, plaque prolapse, and fiber cap damage. Counting data were compared between the two groups using_2 test, Fisher test or one-way ANOVA. Kruskal-Wallis test was used to compare the thickness of Fiber Caps between the two groups. Cohen's statistical analysis was used to analyze the reliability between the observers and among the observers. Results: The difference was statistically significant between the two groups (P 0.05). Twenty-six patients were enrolled in the study, 20 of whom obtained qualified images and 6 of whom were excluded because of the poor quality of OCT images. The rate of plaque prolapse was 65.5% in the lipid plaque group and 49.1% in the non-lipid plaque group. There was no significant difference in the rate of stent adherence between the two groups, with 12.3% in the lipid plaque group and 14.9% in the non-lipid plaque group. There was no significant difference in the rate of poor stent adherence between the two groups. The incidence of plaque prolapse and fibrous cap damage was lower in the non-lipid plaque group. Acute thrombosis in stent is a rare complication of carotid artery stent. However, if the complication is not handled promptly, it will lead to vascular occlusion, neurological deficits, and even affect the outcome of surgery, threatening life. OCT can be used to treat the carotid artery before, during and after stenting. Pulse lesions, the relationship between carotid artery stents and the wall, and the formation of acute thrombosis in stents were observed and recorded. One case report confirmed that OCT could visually record and describe the formation of acute thrombosis in stents. Part V Intravascular optical coherence tomography system for cerebrovascular interventional therapy The evaluation terminology, methods and clinical application of OCT as a new intravascular imaging method using near-infrared light have obvious advantages over conventional intravascular ultrasound (IVUS). OCT can provide more detailed analysis of the internal carotid artery wall and provide more information, including To evaluate the nature of the plaque, identify the unstable plaque and the vascular response to interventional treatment of carotid artery stenosis. This part reviews the evaluation terminology, evaluation methods and clinical application of OCT in cerebrovascular interventional therapy, as well as the future non-development prospects.
【学位授予单位】：第二军医大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R543.4
本文编号：2250225
[Abstract]:Part I: The safety and feasibility of frequency domain optical coherence tomography (FD-OCT) in carotid plaque assessment and carotid artery stenting. Background and purpose: This study analyzed the safety of FD-OCT in carotid plaque assessment and carotid artery stenting by exploring the application of FD-OCT in carotid artery system. Objectives and Methods: From January 2014 to May 2015, carotid angiography was performed in the Department of Neurology, Nanjing General Hospital of Nanjing Military Region, Nanjing Military Region. The two researchers scored 1-10 points on the images respectively. Cohen's statistical analysis was used to analyze the reliability between the observers and within the observers. The difference was statistically significant (P 0.05). Results: A total of 22 patients were included in the study and 44 scans were performed. 40/44 (90.9%) of the eligible images were obtained successfully. There were no surgical-related neurological complications (0%) during OCT. The quality of the images obtained by OCT was high (mean 7.5.9 points). After CAS, clear fibrous cap damage, poor stent attachment and plaque prolapse could be found in the OCT images. Conclusion: This study is the first application of OCT in carotid artery system in China. The study confirms the safety and feasibility of OCT in carotid artery system. OCT can be used to evaluate carotid plaque and carotid artery stenting. The second part is the comparison of the results of symptomatic carotid atherosclerosis and asymptomatic carotid atherosclerosis OCT. Background and purpose: For asymptomatic carotid atherosclerosis patients, it is necessary to determine and assess the nature of the plaque. The morphological characteristics of carotid atherosclerotic plaques provide the basis for the application of OCT in carotid artery system. Objectives and Methods: The study included carotid angiography in the Department of Neurology, Nanjing General Hospital of Nanjing Military Region from January 2014 to May 2015. The patients were diagnosed as carotid atherosclerosis by invasive examination and OCT examination. Patients were divided into two groups according to the symptoms within 6 months before treatment: symptomatic group and asymptomatic group. The degree of stenosis of the lesion vessels was determined by DSA and OCT, and the plaque features observed by OCT images were recorded and compared. The counting data between the two groups were analyzed by_2 test or Fisher test. Cohen's statistical analysis was used. The reliability between observers and within observers was analyzed. The independent risk factors for symptoms were analyzed by binary logistic regression. The consistency of the degree of stenosis of vessel diameter measured by OCT and DSA was examined by Bland-Altman plot test. Results: A total of 52 patients completed OCT, DSA and OCT. Symptomatic patients had higher incidence of VI plaque (68.0% vs. 33.3%, respectively; P = 0.025), higher incidence of macrophage infiltration (52.0% vs. 22.2%, P = 0.043), higher incidence of mural thrombosis (64.0% vs. 37.0%, P = 0.095), and lower incidence of fibrotic plaque (40.0.0% vs. 22.2%, P = 0.043). Logistic regression analysis showed that VI plaque (OR: 13.798, 95% CI: 1.38 to 137.675, P = 0.025) and macrophage infiltration (OR: 5.856, 95% CI: 1.405 to 24.406, P = 0.015) were independent risk factors for carotid stenosis. The incidence of complex plaques in symptomatic carotid stenosis was higher than that in asymptomatic carotid stenosis patients. VI plaque and macrophage infiltration were independent risk factors for carotid stenosis symptoms. Part III Effects of carotid atherosclerotic lipid plaque on carotid stent adherence: An OCT-based study BACKGROUND AND OBJECTIVE: Carotid artery stent has become one of the main methods for the treatment of extracranial carotid artery stenosis. During CAS, stent adherence, plaque prolapse and fibrous cap damage often occur. This study analyzed the relationship between stent adherence and lipid plaque after CAS, and then further explored the branches. Objectives and Methods: Carotid artery angiography was performed in the Department of Neurology, Nanjing General Hospital of Nanjing Military Region from April 2014 to May 2015. The patients were identified as carotid atherosclerosis with OCT and CAS. The relationship between the scaffold and the plaque was recorded in the images. The scaffold adherence was expressed as a percentage of the total number of the scaffolds. The specific layers of the scaffolds were also recorded, such as poor adherence, plaque prolapse, and fiber cap damage. Counting data were compared between the two groups using_2 test, Fisher test or one-way ANOVA. Kruskal-Wallis test was used to compare the thickness of Fiber Caps between the two groups. Cohen's statistical analysis was used to analyze the reliability between the observers and among the observers. Results: The difference was statistically significant between the two groups (P 0.05). Twenty-six patients were enrolled in the study, 20 of whom obtained qualified images and 6 of whom were excluded because of the poor quality of OCT images. The rate of plaque prolapse was 65.5% in the lipid plaque group and 49.1% in the non-lipid plaque group. There was no significant difference in the rate of stent adherence between the two groups, with 12.3% in the lipid plaque group and 14.9% in the non-lipid plaque group. There was no significant difference in the rate of poor stent adherence between the two groups. The incidence of plaque prolapse and fibrous cap damage was lower in the non-lipid plaque group. Acute thrombosis in stent is a rare complication of carotid artery stent. However, if the complication is not handled promptly, it will lead to vascular occlusion, neurological deficits, and even affect the outcome of surgery, threatening life. OCT can be used to treat the carotid artery before, during and after stenting. Pulse lesions, the relationship between carotid artery stents and the wall, and the formation of acute thrombosis in stents were observed and recorded. One case report confirmed that OCT could visually record and describe the formation of acute thrombosis in stents. Part V Intravascular optical coherence tomography system for cerebrovascular interventional therapy The evaluation terminology, methods and clinical application of OCT as a new intravascular imaging method using near-infrared light have obvious advantages over conventional intravascular ultrasound (IVUS). OCT can provide more detailed analysis of the internal carotid artery wall and provide more information, including To evaluate the nature of the plaque, identify the unstable plaque and the vascular response to interventional treatment of carotid artery stenosis. This part reviews the evaluation terminology, evaluation methods and clinical application of OCT in cerebrovascular interventional therapy, as well as the future non-development prospects.
【学位授予单位】：第二军医大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R543.4
【参考文献】
相关期刊论文 前2条
1 ;中国缺血性脑卒中和短暂性脑缺血发作二级预防指南2010[J];中华神经科杂志;2010年02期
2 谢立新;方芳;李辉;方云祥;;动脉粥样硬化的免疫调节与疫苗研制[J];中国药理学通报;2007年03期
，本文编号：2250225
本文链接：https://www.wllwen.com/yixuelunwen/xxg/2250225.html
最近更新
教材专著
