支架释放同时推注造影剂评价支架术后即刻贴壁不良

摘要

目的:通过支架释放同时推注造影剂(Simultaneous injection contrast,SIC),判断支架贴壁情况与光学相干断层成像(optical coherence tomography,OCT),测量支架小梁与血管内膜之间距离,对比评价SIC方法,判断术后即刻支架贴壁情况的实用性.方法:入选21例原位病变的冠心病患者,行支架植入术的同时通过释放支架,同时推注造影剂( SIC)方法判断支架大体的贴壁情况,同时记录支架的型号释放压力等,之后用光学相干断层成像(OCT)精确判断支架的贴壁情况,并对OCT图像每隔1 mm的横截面的支架小梁的贴壁情况进行记录和分析,通过两者的结果对比,评价SIC方法在支架贴壁情况中的实用性.结果:21例患者中共植入支架34枚,其中2个支架节段用SIC及OCT判断均存在贴壁不良,11个支架节段SIC判断贴壁良好,而经OCT检查发现存在＞1％的支架小梁贴壁不良.SIC和OCT检查均为贴壁良好的支架节段有21个.结论:SIC方法是在临床实践中一种简便实用的判断支架贴壁情况的方法,虽然其准确性难以与OCT相媲美,但作为一种简便经济的方法,值得在临床推广使用.%Objective: Using Simultaneous injection contrast ( SIC) during stent inflation to judge in-complete stent apposition (ISA) compared with optical coherence tomography ( OCT) , to evaluate the utility value of SIC in observing stent apposition. Methods:21 coronary heart disease patients were enrolled in this study. When the stent was being released, SIC was done to assist the stent apposition following by the OCT scanning. And the struts apposition in OCT images was analyzed by lmm interval. Then we compared the two results to evaluate the accuracy of SIC. Results:Totally 34stents were launched in the 21 patients, of which 2 stent segments were found with stent malapposition both by SIC and OCT. 21 stent segments were found well ap-posed both by SIC and OCT. 11 stent segments were found well apposed by SIC, and have more than 1 % struts malapposition by OCT. Conclusion:SIC is a simple and useful method to observe the stent apposition, and could help to decide the pressure and whether to post-dilate the stent or not. Though its accuracy is far less than OCT, it will be worthy being applied extensively in clinical practice.