韩燕,袁晓航,高磊

• 1:中国人民解放军总医院第一医学中心心血管内科
• 2:解放军医学院

摘要(Abstract)：

尽管经皮冠状动脉介入治疗技术几经革新，然而由于冠心病患者人口基数大，适行介入治疗的病变复杂性增加，接受冠状动脉介入治疗患者中仍有5%～10%发生支架内再狭窄（ISR）。ISR由多种因素驱动，形成机制复杂且较原位病变预后更差，是目前临床面临的一大挑战。光学相干断层成像（OCT）具有极高的轴向分辨率及接近离体病理水平的解剖成像优势，对ISR致病因素的检出识别能力近似甚至优于血管内超声，在评估新生内膜组织特征、指导针对性个体化介入治疗方面价值显著。2018年欧洲血运重建指南和欧洲冠状动脉腔内影像专家共识均推荐OCT作为指导ISR诊治的重要手段，近年来多种腔内影像技术指导介入治疗的策略被相继提出，各具特点。因此，本文对OCT在识别ISR原因方面的潜在价值作一综述，介绍近年来OCT指导ISR介入治疗研究结果和相关治疗流程。

关键词(KeyWords)： 支架内再狭窄;光学相干断层成像;新生内膜;新生动脉粥样硬化;介入治疗

Abstract:

Keywords:

基金项目(Foundation): 国家自然科学基金项目（81970443、81671731）;; 首都临床特色应用研究项目（Z171100001017158）

作者(Author): 韩燕,袁晓航,高磊

参考文献(References)：

• [1] Mohamed MO,Polad J,Hildick-Smith D,et al. Impact of coronary lesion complexity in percutaneous coronary intervention:one-year outcomes from the large,multicentre e-Ultimaster registry[J]. EuroIntervention,2020,16(7):603-612. DOI:10.4244/EIJ-D-20-00361.
• [2] Cassese S,Byrne RA,Schulz S,et al. Prognostic r o l e of restenosis in 10 004 patients undergoing routine control angiography after coronary stenting[J]. Eur Heart J,2015,36(2):94-99. DOI:10.1093/eurheartj/ehu383.
• [3] Alfonso F,AugéJM,Zueco J,et al. Long-term results(three to five years)of the restenosis intrastent:balloon angioplasty versus elective stenting(RIBS)randomized study[J]. J Am Coll Cardiol,2005,46(5):756-760. DOI:10.1016/j.jacc.2005.05.050.
• [4] Tamez H,Secemsky EA,Valsdottir LR,et al. Longterm outcomes of percutaneous coronary intervention for in-stent restenosis among Medicare beneficiaries[J]. EuroIntervention,2021,17(5):e380-e387. DOI:10.4244/EIJ-D-19-01031.
• [5] Moussa ID,Mohananey D,Saucedo J,et al. Trends and outcomes of restenosis after coronary stent implantation in the United States[J]. J Am Coll Cardiol,2020,76(13):1521-1531. DOI:10.1016/j.jacc.2020.08.002.
• [6] Alfonso F,Coughlan JJ,Giacoppo D,et al. Management of in-stent restenosis[J]. EuroIntervention,2022,18(2):e103-e123. DOI:10.4244/EIJ-D-21-01034.
• [7] Goto K,Zhao Z,Matsumura M,et al. Mechanisms and patterns of intravascular ultrasound in-stent restenosis among bare metal stents and first-and second-generation drug-eluting stents[J]. Am J Cardiol,2015,116(9):1351-1357.DOI:10.1016/j.amjcard.2015.07.058.
• [8] Alfonso F,Sandoval J,Cárdenas A,et al. Optical coherence tomography:from research to clinical application[J]. Minerva Med,2012,103(6):441-464. DOI:10.5694/mja12.11570.
• [9] Neumann FJ,Sousa-Uva M,Ahlsson A,et al. 2018 ESC/EACTS Guidelines on myocardial revascularization[J]. Eur Heart J,2019,40(2):87-165. DOI:10.1093/eurheartj/ehy394.
• [10] R?ber L,Mintz GS,Koskinas KC,et al. Clinical use o f intracoronary imaging. Part 1:guidance and optimization of coronary interventions. An expert consensus document of the European Association of Percutaneous Cardiovascular Interventions[J]. Eur Heart J,2018,39(35):3281-3300.DOI:10.1093/eurheartj/ehy285.
• [11] Buccheri S,Franchina G,Romano S,et al. Clinical outcomes following intravascular imaging-guided versus coronary angiographyguided percutaneous coronary intervention with stent implantation:a systematic review and bayesian network meta-analysis of 31 studies and 17,882 patients[J]. JACC Cardiovasc Interv,2017,10(24):2488-2498. DOI:10.1016/j.jcin.2017.08.051.
• [12] Giustino G,Colombo A,Camaj A,et al. Coronary in-stent restenosis:JACC state-of-the-art review[J]. J Am Coll Cardiol,2022,80(4):348-372. DOI:10.1016/j.jacc.2022.05.017.
• [13] Alfonso F,Byrne RA,Rivero F,et al. Current treatment of instent restenosis[J]. J Am Coll Cardiol,2014,63(24):2659-2673. DOI:10.1016/j.jacc.2014.02.545.
• [14] Farooq V,Gogas BD,Serruys PW. Restenosis:delineating the numerous causes of drug-eluting stent restenosis[J]. Circ Cardiovasc Interv,2011,4(2):195-205. DOI:10.1161/CIRCINTERVENTIONS.110.959882.
• [15] Cassese S,Byrne RA,Tada T,et al. Incidence and predictors of restenosis after coronary stenting in 10 004 patients with surveillance angiography[J]. Heart,2014,100(2):153-159. DOI:10.1136/heartjnl-2013-304933.
• [16] Alfonso F. Treatment of drug-eluting stent restenosis the new pilgrimage:quo vadis?[J]. J Am Coll Cardiol,2010,55(24):2717-2720. DOI:10.1016/j.jacc.2010.03.026.
• [17] Byrne RA,Cassese S,Windisch T,et al. Dif ferential relative efficacy between drug-eluting stents in patients with bare metal and drug-eluting stent restenosis; evidence in support of drug resistance:insights from the ISAR-DESIRE and ISAR-DESIRE2 trials[J]. EuroIntervention,2013,9(7):797-802.DOI:10.4244/EIJV9I7A132.
• [18] Byrne RA,Joner M,Tada T,et al. Restenosis in bare metal and drug-eluting stents:distinct mechanistic insights from histopathology and optical intravascular imaging[J]. Minerva Cardioangiol,2012,60(5):473-489. DOI:10.1016/j.intfin.2012.04.004.
• [19]郝伟，赵晨，胡思宁，等.冠状动脉药物洗脱支架内再狭窄的最新研究进展[J].中国介入心脏病学杂志，2023,31(1):63-68. DOI:10.3969/j.issn.1004-8812.2023.01.010.
• [20] Latib A,Mussardo M,Ielasi A,et al. Long-term outcomes after the percutaneous treatment of drug-eluting stent restenosis[J].JACC Cardiovasc Interv,2011,4(2):155-164. DOI:10.1016/j.jcin.2010.09.027.
• [21] Moussa ID,Mohananey D,Saucedo J,et al. Trends and outcomes of restenosis after coronary stent implantation in the United States[J]. J Am Coll Cardiol,2020,76(13):1521-1531. DOI:10.1016/j.jacc.2020.08.002.
• [22]杨旺伟，刘毅，李妍，等.支架内再狭窄38例光学相干断层成像影像分析[J].中国介入心脏病学杂志，2020,28(3):138-143. DOI:10.3969/j.issn.1004-8812.2020.03.004.
• [23] Erdogan E,Bajaj R,Lansky A,et al. Intravascular imaging for guiding in-stent restenosis and stent thrombosis therapy[J]. J Am Heart Assoc,2022,11(22):e026492. DOI:10.1161/JAHA.122.026492.
• [24] Abouelnour A,Gori T. Intravascular imaging in coronary stent restenosis:prevention,characterization,and management[J].Front Cardiovasc Med,2022,9:843734. DOI:10.3389/fcvm.2022.843734.
• [25] Gonzalo N,Serruys PW,Okamura T,et al. Optical coherence tomography patterns of stent restenosis[J]. Am Heart J,2009,158(2):284-293. DOI:10.1016/j.ahj.2009.06.004.
• [26] Yamamoto W,Fujii K,Otsuji S,et al. Optical coherence tomography characteristics of in-stent restenosis after drugeluting stent implantation:a novel classification and its clinical significance[J]. Heart Vessels,2020,35(1):38-45.DOI:10.1007/s00380-019-01461-7.
• [27] Chen Z,Matsumura M,Mintz GS,et al. Prevalence and impact of neoatherosclerosis on clinical outcomes after percutaneous treatment of second-generation drug-eluting stent restenosis[J]. Circ Cardiovasc Interv,2022,15(9):e011693. DOI:10.1161/CIRCINTERVENTIONS.121.011693.
• [28] Adriaenssens T,Joner M,Godschalk TC,et al. Optical coherence tomography findings in patients with coronary stent thrombosis:a report of the PRESTIGE Consortium(Prevention of Late Stent Thrombosis by an Interdisciplinary Global European Effort)[J]. Circulation,2017,136(11):1007-1021.DOI:10.1161/CIRCULATIONAHA.117.026788.
• [29] Ali ZA,Roleder T,Narula J,et al. Increased thinc a p neoatheroma and periprocedural myocardial infarction in drug-eluting stent restenosis:multimodality intravascular imaging of drug-eluting and bare-metal stents[J]. Circ Cardiovasc Interv,2013,6(5):507-517. DOI:10.1161/CIRCINTERVENTIONS.112.000248.
• [30] Kang SJ,Mintz GS,Akasaka T,et al. Optical coherence tomographic analysis of in-stent neoatherosclerosis after drugeluting stent implantation[J]. Circulation,2011,123(25):2954-2963. DOI:10.1161/CIRCULATIONAHA.110.988436.
• [31] Nakamura D,Dohi T,Ishihara T,et al. Predictors and outcomes of neoatherosclerosis in patients with in-stent restenosis[J]. EuroIntervention,2021,17(6):489-496.DOI:10.4244/EIJ-D-20-00539.
• [32] Yin D,Mintz GS,Song L,et al. In-stent restenosis characteristics and repeat stenting underexpansion:insights from optical coherence tomography[J]. EuroIntervention,2020,16(4):e335-e343. DOI:10.4244/EIJ-D-18-01191.
• [33] Tada T,Kadota K,Hosogi S,et al. Association between tissue characteristics evaluated with optical coherence tomography and mid-term results after paclitaxel-coated balloon dilatation for instent restenosis lesions:a comparison with plain old balloon angioplasty[J]. Eur Heart J Cardiovasc Imaging,2014,15(3):307-315. DOI:10.1093/ehjci/jet165.
• [34] Tada T,Kadota K,Hosogi S,et al. Association between tissue characteristics assessed with optical coherence tomography and mid-term results after percutaneous coronary intervention for in-stent restenosis lesions:a comparison between balloon angioplasty,paclitaxel-coated balloon dilatation,and drug-eluting stent implantation[J]. Eur Heart J Cardiovasc Imaging,2015,16(10):1101-1111. DOI:10.1093/ehjci/jev031.
• [35] Miura K,Tada T,Habara S,et al. Optical coherence tomography predictors for recurrent restenosis after paclitaxel-coated balloon angioplasty for drug-eluting stent restenosis[J]. Circ J,2018,82(11):2820-2828. DOI:10.1253/circj.CJ-18-0464.
• [36] Lee JH,Jung HW,Kim JS,et al. Different neointimal pattern in early vs. late in-stent restenosis and clinical outcomes after drug-coated balloon angioplasty-an optical coherence tomography study[J]. Circ J,2018,82(11):2745-2752.DOI:10.1253/circj.CJ-18-0619.
• [37] Xhepa E,Bresha J,Joner M,et al. Clinical outcomes by optical characteristics of neointima and treatment modality in patients with coronary in-stent restenosis[J]. EuroIntervention,2021,17(5):e388-e395. DOI:10.4244/EIJ-D-20-00662.
• [38] Parviz Y,Shlofmitz E,Fall KN,et al. Utility of intracoronary imaging in the cardiac catheterization laboratory:comprehensive evaluation with intravascular ultrasound and optical coherence tomography[J]. Br Med Bull,2018,125(1):79-90. DOI:10.1093/bmb/ldx049.
• [39] Lawton JS,Tamis-Holland JE,Bangalore S,et al. 2021 ACC/AHA/SCAI guideline for coronary artery revascularization:executive summary:a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines[J]. J Am Coll Cardiol,2022,79(2):197-215. DOI:10.1016/j.jacc.2021.09.005.
• [40] Shlofmitz E,Case BC,Chen Y,et al. Waksman in-stent restenosis classfication:a mechanism-based approach to the treatment of restenosis[J]. Cardiovasc Revasc Med,2021,33:62-67. DOI:10.1016/j.carrev.2021.06.004.
• [41] Pal N,Din J,O’Kane P. Contemporary management of stent failure:part one[J]. Interv Cardiol,2019,14(1):10-16. DOI:10.15420/icr.2018.39.1.
• [42] Stefanini GG,Alfonso F,Barbato E,et al. Management of myocardial revascularisation failure:an expert consensus document of the EAPCI[J]. EuroIntervention,2020,16(11):e875-e890. DOI:10.4244/EIJ-D-20-00487.
• [43]袁晓航，张颖倩，章明，等.光学相干断层扫描三步法优化冠状动脉支架再狭窄介入治疗的初步研究[J].中华老年多器官疾病杂志，2022,21(5):321-325. DOI:10.11915/j.issn.1671-5403.2022.05.069.