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在OCT指导的PCI期间ISR与De Novo损伤治疗:来自LightLab倡议的见解

Brian A Bergmark^1,2, Mordechai Golomb³, Julia F Kuder²

¹CTO/Complex Coronary Intervention Program, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.

Journal of the Society for Cardiovascular Angiography & Interventions

|August 12, 2024

概括

穿皮冠状动脉干预用于静脉静脉复缩 (ISR) 是具有挑战性的. 在ISRPCI程序中使用光学连贯性断层扫描 (OCT) 显示了更长的程序时间和更差的支架扩张,突出了OCT在优化治疗中的作用.

科学领域:

心血管干预心血管干预
干预心脏病学干预心脏病学
医疗成像医学成像

背景情况:

通过皮肤冠状动脉干预 (PCI) 治疗静脉静脉复缩 (ISR) 的长期结果仍然不理想.
对于ISR PCI存在有限的详细程序数据,这阻碍了有效的损伤评估和治疗策略.
了解程序细微差别对于改善ISR患者的治疗结果至关重要.

研究的目的:

为了评估光学连贯性断层扫描 (OCT) 引导的ISRPCI与de novo病变相比的程序特征和结果.
评估海外国家和地区对ISR治疗决策和支架优化的影响.
确定导致ISR PCI急性程序成功的因素.

主要方法:

光实验室倡议在美国17家医院 (2019-2021) 招募了2592个OCT指导的PCI程序.
程序数据,包括损伤评估和支架部署,同时收集.
使用OCT成像进行手术前的病变评估和手术后的支架评估,将ISR (n=458) 与de novo病变进行比较.

主要成果:

与新生病变相比,ISR病变更复杂 (C型:64.8%与52.9%) 并与更高的股骨接触率 (46.4%与37.7%) 相关.
在ISR PCI (94.2% vs. 85.2%) 中,OCT显著影响治疗决策的频率更高.
ISR PCI采用了更先进的损伤修饰技术 (评分气球,切割气球,切除术),并导致更长的手术时间 (62分钟与51分钟相比),最终最小支架面积和扩张更低.

结论:

在OCT指导的ISRPCI涉及更复杂的病变,需要更多地使用先进的技术.
尽管干预增加了,但ISR PCI程序产生了低于最佳的支架扩张.
海外国家和地区在指导ISR治疗决策方面发挥着关键作用,有可能改善这一高风险群体的治疗结果.

关键词:

在静脉支架内恢复缩.血管内成像血管内成像光学连贯性断层扫描 (optical coherence tomography) 是一种光学连贯性断层扫描技术.通过皮肤进行冠状动脉干预.

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