2022 年第 6 期 第 17 卷

应用血管内超声与光学相干断层扫描杂交融合分析冠状动脉支架置入后钙化斑块进展情况和前体组织成分

Assessment of progression of coronary calcification and tissue precursors by hybrid fusion of intravascular ultrasound and optical coherence tomography after stent implantation

作者：曾亚平张瑶俊索旻师树田高海

英文作者：Zeng Yaping Zhang Yaojun Suo Min Shi Shutian Gao Hai

单位：首都医科大学附属北京安贞医院心内急诊冠状动脉病区北京市心肺血管疾病研究所，北京100029

英文单位：Intracardiac Emergency Coronary Disease Area Beijing Anzhen Hospital Capital Medical University Beijing Institute of Heart Lung and Blood Vessel Diseases Beijing 100029 China

关键词：急性冠状动脉综合征；生物可吸收支架；钙化灶；血管内超声；光学相干断层扫描

英文关键词：Acutecoronarysyndrome；Bioresorbablevascularscaffold;Calcifiedlesion;Intravascularultrasound;Opticalcoherencetomography

• 摘要：

• 目的 探讨灰阶血管内超声（IVUS）、IVUS-虚拟组织学(VH)和光学相干断层扫描（OCT）评估接受生物可吸收支架置入患者从基线到5年随访钙化斑块进展情况和前体组织成分分析。方法 选取首都医科大学附属北京安贞医院接受生物可吸收支架置入的急性冠状动脉综合征患者15例（共16个病灶）。利用解剖标志和不透射线标志融合OCT和IVUS图像，并匹配基线和5年随访图像。以杂交融合诊断的钙化灶为金标准，评估IVUS和OCT诊断钙化的敏感度、特异度和一致性，分析OCT和IVUS-VH检测的主要钙化前体组织成分，比较5年后支架内外钙化灶的钙化面积和钙化弧度与术后即刻的变化。结果 灰阶IVUS、IVUS-VH和OCT图像和随访匹配最终入选72对融合横断面，5年随访时发现46个钙化灶，其中24个（52.2%）为钙化进展，22个（47.8%）为新生钙化。OCT分析46个钙化灶主要前体组织成分为脂质（33个，71.2%），IVUS-VH分析主要前体组织成分为坏死核心（34个，73.9%）。5年后，OCT检测支架内和支架外钙化面积均高于术后即刻（均P＜0.05）。结论 通过使用OCT和IVUS融合成像发现，置入生物可吸收支架患者5年随访普遍出现钙化进展，OCT和IVUS-VH检测钙化灶主要前体组织成分分别为脂质和坏死核心。

• Objective To assess progression of coronary calcification and tissue precursors by grayscale intravascular ultrasound (IVUS), IVUS-virtual histology (IVUS-VH), and optical coherence tomography(OCT) from baseline to 5-year follow-up in patients treated with bioresorbable vascular scaffolds (BVS) implantation. Methods Fifteen patients with acute coronary syndrome (totally 16 lesions) who underwent BVS implantation in Beijing Anzhen Hospital, Capital Medical University were selected. OCT and IVUS images were fused with anatomical and radiopaque markers, and baseline and 5-year follow-up images were matched. Taking the calcified lesions diagnosed by hybrid fusion as the gold standard, the sensitivity, specificity and consistency of IVUS or OCT in the diagnosis of calcification were evaluated. The main tissue components of calcified precursors detected by OCT and IVUS-VH were analyzed. The calcification area and calcification radian of calcified lesions inside and outside the stent after 5 years were compared with immediately after operation. Results   Grayscale IVUS, IVUS-VH and OCT images were matched with follow-up, and 72 pairs of fusion cross sections were finally selected. Totally 46 calcified lesions were found during 5-year follow-up, 24(52.2%) of them were calcification progression and 22(47.8%) of them were new calcification. The main tissue precursor component of 46 calcified lesions was lipid plaque (33, 71.2%) by OCT analysis, and the main tissue precursor component was necrotic core (34, 73.9%) by IVUS-VH analysis. After 5 years, the calcification area in and out of stent detected by OCT was higher than that immediately after operation (all P<0.05). Conclusions  By using OCT and IVUS fusion imaging, it is found that calcification progress generally occurred in patients with BVS after 5-year follow-up. The main precursor tissue component of calcified lesions was lipid plaque detected by OCT and was necrotic core detected by IVUS-VH, respectively.