- 作者：Masataka Nakano ; MD?/sup> ; Marc Vorpahl ; MD?/sup> ; Fumiyuki Otsuka ; MD?/sup> ; Masanori Taniwaki ; MD&dagger ; ; Saami K. Yazdani ; PhD?/sup> ; Aloke V. Finn ; MD&Dagger ; ; Elena R. Ladich ; MD?/sup> ; Frank D. Kolodgie ; PhD?/sup> ; Renu Virmani ; MD?/sup> ; rvirmani@cvpath.org
- 关键词：histology ; intracoronary imaging ; intravascular ultrasound ; near infrared light ; optical frequency domain imaging ; stents ; stent thrombosis
- 刊名：JACC: Cardiovascular Imaging
- 出版年：2012
- 出版时间：January, 2012
- 年：2012
- 卷：5
- 期：1
- 页码：71-82
- 全文大小：2745 K
Objectives
This study sought to examine the capability of optical frequency domain imaging (OFDI) to characterize various morphological and histological responses to stents implanted in human coronary arteries.Background
A precise assessment of vascular responses to stents may help stratify the risk of future adverse events in patients who have been treated with coronary stents.
Methods
Fourteen human stented coronary segments with implant duration ? month from 10 hearts acquired at autopsy were interrogated ex vivo by OFDI and intravascular ultrasound (IVUS). Comparison with histology was assessed in 134 pairs of images where the endpoints were to investigate: 1) accuracy of morphological measurements; 2) detection of uncovered struts; and 3) characterization of neointima.
Results
Although both OFDI and IVUS provided a good correlation of neointimal area with histology, the correlation of minimum neointimal thickness was inferior in IVUS (R2 = 0.39) as compared with OFDI (R2 = 0.67). Similarly, IVUS showed a weak correlation of the ratio of uncovered to total stent struts per section (RUTSS) (R2 = 0.24), whereas OFDI maintained superiority (R2 = 0.66). In a more detailed analysis by OFDI, identification of individual uncovered struts demonstrated a sensitivity of 77.9 % and specificity of 96.4 % . Other important morphological features such as fibrin accumulation, excessive inflammation (hypersensitivity), and in-stent atherosclerosis were characterized by OFDI; however, the similarly dark appearance of these tissues did not allow for direct visual discrimination. The quantitative analysis of OFDI signal reflections from various in-stent tissues demonstrated distinct features of organized thrombus and accumulation of foamy macrophages.
Conclusions
The results of the present study reinforce the potential of OFDI to detect vascular responses that may be important for the understanding of long-term stent performance, and indicate the capability of this technology to serve as a diagnostic indicator of clinical success.