Application Of Optical Coherence Tomography In Carotid Atherosclerotic Lesions And Neointima

Part one:Evaluation of carotid atherosclerotic plaque and immediate situation post-stent implantation in patients with diabetes and non-diabetes by optical coherence tomographyBackground and Purpose—Optical coherence tomography(OCT)study of coronary artery had shown that coronary atherosclerotic plaques in diabetes mellitus(DM)patients had more unstable characteristics than non-DM patients.However,the characteristics of carotid atherosclerotic plaques in patients with DM were not yet clear.The purpose was to evaluate the characteristics of carotid atherosclerotic plaques and immediate situation post carotid artery stent(CAS)in patients with DM and non-DM using OCT.Methods—This study retrospectively included patients who received CAS for carotid artery stenosis and accepted OCT examination at the same time in the Department of Neurology,Jingling Hospital from January 2014 to March 2019.Patients were divided into the diabetic and non-diabetic groups according to the presence or absence of diabetes,the characteristics of carotid atherosclerotic plaques and immediate situation post carotid artery stent(CAS)were evaluated by OCT.Results—Finally,46 patients were included for analysis,including 20 in the diabetic group and 26 in the non-diabetic group.Compared with non-diabetic patients,the incidence of thin-cap fibroatheromas[8(40%)vs.2(7.7%),P=0.023],the incidence of plaque ruptures[11(55%)vs.6(23.1%),P=0.026]and the incidence of macrophages[12(60%)vs.8(30.8%),P=0.047]in patients with diabetes were all higher.Carotid plaques in diabetic and non-diabetic patients had no statistical differences in plaque type,cholesterol crystals,microchannels,calcified nodules,plaque erosion,and thrombosis.There were no statistical differences between diabetic and non-diabetic patients in stent adherence,tissue prolapse,and stent margin dissection.Conclusions—The incidence of carotid atherosclerotic plaques with thin-cap fibroatheromas,plaque rupture,and macrophages is higher in diabetic patients than in non-diabetic patients,suggesting that carotid plaques are more unstable in diabetic patients.OCT may be a powerful tool for neurointerventionists to reduce the adverse technical results of CAS,such as poor adherence and tissue prolapse.Part two:Different Characteristics Between Homogeneous and Heterogeneous Neointima After Carotid Stenting:Optical Coherence TomographyBackbround and Purpose—OCT study of coronary artery had shown that the heterogeneous intima after stenting not only had a larger intimal area,but also was a precursor to the occurrence of neoatherosclerosis,and is associated with adverse long-term outcomes.However,the characteristics of heterogeneous intima after CAS were not yet clear.The purpose of this study was to reveal the differences in the characteristics of homogeneous and heterogeneous intima after CAS with OCT.Methods—A retrospective analysis of patients undergoing carotid stenting who accepted both digital subtraction angiography and OCT assessment for follow-up examination at Jingling Hospital from March 2016 to March 2019.According to the morphology of the neointimal light scattering of the OCT images,the patients were divided into a homogeneous neointima group and a heterogeneous neointima group.The qualitative and quantitative analysis of the neointima was performed by OCT.Results—A total of 17 patients were included in the analysis,of which 9 patients showed homogeneous neointima and 8 patients showed heterogeneous neointima.For qualitative OCT analysis,patients with heterogeneous neointima were not only in the whole lumen of analysis[0(0%)vs.6(75%),P=0.002]but also at the smallest lumen[0(0%)vs.4(50%),P=0.029]showed higher rates of neoatherosclerosis.The microchannel rate[1(11.1%)vs.6(75%),P=0.015]of the heterogeneous neointima group was also higher than that of the homogeneous neointima group.For quantitative OCT analysis,the average neointimal area of patients in the heterogeneous neointima group was larger[5.45(4.04,7.63)vs.12.11(5.88,12.61),P=0.034],and the neointima was thicker[0.53(0.45,0.62)vs.0.97(0.68,1.1 1),P=0.0111.Conclusions-OCT displayed that neointima showed different patterns after CAS.In heterogeneous intima,unstable features were more common.Heterogeneous intima may be related to atherosclerosis progression of neointima after CAS.