Comparative Study Of Intravascular Ultrasound With Optical Coherence Tomography In Coronary Interventional Therapy

Objective: In order to reasonably select imaging system to guide PCI operation,reduce operation risk and complications,and improve prognosis and the quality of patients’ life with cardiovascular disease,the analysis of optical coherence tomography(OCT)on lesion properties and parameters,as well as the immediately therapeutic effects and various indexes in the long-term follow-up after interventional surgery were compared with intravascular ultrasound(IVUS)to evaluate the therapeutic effect.Methods: 220 patients who had been diagnosed with coronary artery disease and agreed to accept interventional therapy from January 2018 to January 2020 in the General Hospital of Heilongjiang Agricultural Reclamation administration and Harbin Medical University were selected.According to the digital random table method,they were divided into 110 cases in the study group and 110 cases in the control group.110 patients of control group underwent percutaneous coronary intervention under the guidance of intravascular ultrasound.All images were captured by H749ILAB220C270 intravascular ultrasound instrument produced by Boston Scientific company.Firstly,the patients were injected with nitroglycerin 200 to 400 μ g into the coronary artery.Then,the automatic retraction system is used to retract at the speed of 1 mm / s.The images should cover a segment of 5 mm before and after the vascular lesion.110 patients of study group underwent percutaneous coronary intervention under the guidance of optical coherence tomography equipment produced by American light lab company.Firstly,the 2.4F imaging catheter was sent to the distal end of the coronary target and connected with the OCT imaging system.Then,contrast medium was used to block blood,and the imaging catheter automatically was retracted at the speed of 20-25 mm / s with the maximum imaging speed of 100 frames/ s.According to the specific conditions,the diseased blood vessels scanned each time is 50 mm long.The blood was blocked about 3-5 seconds each time from the injection of contras medium to the completion of imaging.During the examination,the patients’ symptoms,ECG and invasive aortic pressure were strictly observed.The indexes of the two groups were observed and analyzed.Preoperative lesion characters include plaque rupture,patch erosion,calcified nodules,lipid plaque,fibrous plaque and other reasons.Preoperative lesion parameters include minimum lumen area(MLA),reference vessel diameter,lesion length,proximal reference vessel area,distal reference vessel area and bifurcation lesion ratio.Postoperative indexes include the number of stents,post expansion times,immediate support edge interlayer,immediate thrombosis,poor adhesion,minimum stent area(MSA)after stent implantation and bifurcated double stenting.The stent thrombosis,support edge interlayer,poor adherence of support to wall and tissue prolapse were involved in the long term follow-up 12 months after operation.Results: The preoperative lesion analysis showed that compared with IVUS group,more plaque rupture and plaque erosion were observed(P < 0.05)as well as few lipid plaques and fibrous plaques in OCT group(P < 0.05).however,there was no significant difference in calcified nodules and other causes observed in OCT group(P > 0.05).The analysis of preoperative lesion measurement parameters showed no significant difference in minimum lumen area(MLA),reference vessel diameter,lesion length,proximal and distal reference vessel area,and bifurcation lesion ratio between two groups(P > 0.05).Compared with IVUS group,there was no significant difference in the number of stents,the minimum stent area(MSA)and the number of bifurcated double stents in OCT group(P > 0.05),whereas the expansion times,stent edge dissection,thrombosis and poor postoperative adhesion in OCT increased significantly(P < 0.05).Compared with IVUS group,there was no significant difference in stent edge dissection in OCT study group(P > 0.05),however more stent thrombosis,poor stent adhesion and tissue prolapse was observed in OCT group(P < 0.05).Conclusion: OCT is significantly better than IVUS in analyzing the characters of plaque and the causes of coronary lumen stenosis because of the advantage of high resolution.More adverse stent adhesion reactions and immediate throm bosis are observed by OCT than IVUS so that OCT plays an important clinica l guiding role to increase the expansion times after stent implantation and impr ove stent adhesion.The postoperative complications of stent thrombosis,stent a dhesion and intimal prolapse are observed more accurately by OCT than IVUS in the long-term follow-up,so as to provide basis for treatment of long-term complications in time and guiding patients’ postoperative administration.