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旋磨术

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腔内影像学与最小支架面积

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Pre-reading

最小支架面积(minimum stent area, MSA)已被临床确定为一个可预测再狭窄、血栓形成和缺血的重要指标。以下文献结合各种临床实践使用腔内影像学通过MSA这一参数明确支架膨胀质量。


2015年7月由Maehara A, Matsumura M, Mintz GS三位腔内影像大腕儿联合撰写的腔内影像学评估和定量支架置入结果的综述“Assessment and Quantitation of Stent Results by Intracoronary Optical Coherence Tomography”。


2016年1月“Optimal threshold of post intervention minimum stent area to predict in-stent restenosis in small coronary arteries: An optical coherence tomography analysis”介绍了OCT指导下明确PCI干预后可预测支架内再狭窄的MSA理想阈值。


2016年11月"Optical coherence tomography compared with intravascular ultrasound and with angiography to guide coronary stent implantation (ILUMIEN III: OPTIMIZE PCI): a randomised controlled trial"随机对照了OCT、IVUS与冠脉造影指导下支架置入的预后，说明OCT指导PCI，其MSA与IVUS引导的PCI相似。


2018年1月“Optical frequency-domain imaging findings to predict good stent expansion after rotational atherectomy for severely calcified coronary lesions”指出严重冠脉钙化病变旋磨后达到血管内膜钙化最小厚度且实现钙化病变有效剥离与良好的支架扩张呈正相关。在临床中，建议将以上两个终点定为旋磨的目标，以确保良好的支架扩张。


2018年9月“Intravascular ultrasound assessment of the effects of rotational atherectomy in calcified coronary artery lesions”介绍了经IVUS明确的钙化病变旋磨后的腔内影像学特征。


2018年10月“Effect of orbital atherectomy in calcified coronary artery lesions as assessed by optical coherence tomography”阐述了在41例钙化病变中通过OCT观察到的冠脉旋磨后最佳支架扩张状态下最大钙角成角处MSA≥6.1 mm2或支架扩张应≥90%。


2019年3月“Characteristics of abnormal post-stent optical coherence tomography findings in hemodialysis patients”通过OCT对血透和非血透患者支架置入后的边缘夹层、膨胀指数（expansion index = minimum stent area/mean reference area）和支架偏心指数（stent eccentricity index = minimum stent diameter/maximum stent diameter）进行了对比，发现了远端边缘夹层、支架膨胀不良和支架偏心在血透患者中高发的特点。


2019年4月最新发布的“Intravascular Ultrasound Assessment of In-Stent Restenosis in Saphenous Vein Grafts”介绍了对大隐静脉病变（saphenous vein grafts ，SVG）再次血运重建行PCI的IVUS质控参考阈值，将MSA<5 mm2定义为支架膨胀不良（Stent underexpansion ）。


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