光学相干断层成像纵向评估颈动脉支架置入后组织脱垂
Longitudinal evaluation of tissue prolapse after carotid stenting by optical coherence tomography
施璇 1韩云飞 1许晓慧 1杨晴雯 2王芳 1殷勤 1刘锐 1刘新峰1
作者信息
- 1. 南京大学医学院附属金陵医院(东部战区总医院)神经内科,南京 210002
- 2. 东南大学医学院第二临床学院(东部战区总医院)神经内科,南京 210002
- 折叠
摘要
目的 利用光学相干断层成像(OCT)评估颈动脉支架置入术后组织脱垂的特征,分析不同组织脱垂类型与临床特征、术前斑块形态的相关性,并随访支架内新生内膜增生(NIH)情况.方法 收集2018年7月至2019年12月于南京大学医学院附属金陵医院(东部战区总医院)神经内科行颈内动脉支架置入术和手术前后OCT评估的病例.通过OCT评估术前斑块特征与术后即刻组织脱垂性质.根据组织脱垂性质分成平滑组织脱垂(STP)和不规则和(或)伴有强衰减信号的组织脱垂(I/HTP)两类.分析I/HTP与临床特征、术前斑块特征间的相关性,并总结NIH情况.结果 共纳入29例患者,其中23例(79.3％)伴有组织脱垂,包括9例伴有I/HTP、14例伴有STP.相较STP病变,伴有I/HTP的病变更多为富脂斑块(7/9比2/14,P=0.007),且多伴有斑块破裂(7/9比4/14,P=0.036).此外,伴有I/HTP病变的组织脱垂纵向总长度相较STP病变似乎更长,但差异无统计学意义[3.0(1.5,4.6)mm比1.1(0.7,3.2)mm,Z=1.294,P=0.201].共6例患者接受OCT随访,平均随访6.7个月,其中3例的I/HTP病变均发生重度异质型NIH(50.1％～61.8％),而1例的STP病变和2例的没有组织脱垂的病变仅有轻度NIH.结论 I/HTP相较STP更常出现在具有较大脂质核心和(或)纤维帽破裂的病变中,提示两者形成机制及预后可能不同,需大样本研究进一步论证.
Abstract
Objective To assess the prevalence and type of tissue prolapse(TP)occurring after endovascular treatment(ET),investigate the association between TP types and plaque morphological characteristics before ET,and observe in-stent neointimal hyperplasia(NIH)using optical coherence tomography(OCT).Methods Patients who underwent carotid artery stenting and received pre-and post-ET OCT assessment at Jinling Hospital between July 2018 and December 2019 were collected.Baseline plaque characteristics and TP features were evaluated using OCT.The TPs were classified into two categories:smooth TP(STP)and irregular and/or high attenuated TP(I/HTP).The association between I/HTP and plaque characteristics was analyzed,while NIH feature was also summarized.Results A total of 29 patients were included in the study,of whom 23 patients(79.3％)presented with TP.Among these 23 patients,9 were classified as I/HTP and 14 were classified as STP.Compared with STP,I/HTP was more commonly observed in lipid-rich plaques(7/9 vs 2/14,P=0.007),and lesions with cap rupture(7/9 vs 4/14,P=0.036).Additionally,the longitudinal length of TP appeared to be longer in cases with I/HTP compared to those with STP[3.0(1.5,4.6)mm vs 1.1(0.7,3.2)mm,Z=1.294,P=0.201].Six patients underwent OCT follow-up for a mean duration of 6.7 months,of whom 3 patients with I/HTP showed severe heterogeneous NIH(50.1％-61.8％),while 1 patient with STP and 2 patients without TP only demonstrated mild NIH.Conclusions The study observed that I/HTP was commonly found in plaques with larger lipid core and/or cap rupture,and suggested a potential relationship between I/HTP and NIH.These preliminary findings obtained from a limited sample should be verified by prospective large-scale studies.
关键词
体层摄影术,光学相干/颈动脉/组织脱垂/支架/新生内膜增生Key words
Tomography,optical coherence/Carotid arteries/Tissue prolapse/Stents/Neointimal hyperplasia引用本文复制引用
基金项目
国家重点研发计划(2017YFC1307901)
国家自然科学基金(81530038)
国家自然科学基金(81901218)
出版年
2024
NETL
NSTL
万方数据