支架内新生斑块在体FD-OCT和iMAP-IVUS的研究

Drug eluting stents are widely used in clinic for its effectiveness in reducing coronary restenosis, but late stent thrombosis (LST) can cause severe acute coronary events. With the development of clinical intravascular imaging technology, such as intravascular optical coherence tomography (OCT) and intravascular ultrasound (IVUS), human in-stent neoatherosclerosis has been documented recently and further validated by pathological study. More attentions focus on in-stent neoatherosclerosis because its rupture could result in LST and severe clinical events. However, the mechanism of in-stent neoatherosclerosis is still unkown. The correlation between intravascular modality imaging and pathologic examination for assessment of in-stent neoatherosclerosis needs to be further confirmed. Our preliminary research results showed that in-stent neoatherosclerosis could be induced by feeding cholesterol diet after stent implant in rabbit iliac artery. So by using rabbit iliac artery in-stent neoatherosclerosis model under different cholesterol diet conditions,our present study represents an in vivo imaging and histopathological correlation study for assessment of in-stent atherosclerosis. The possible relative factors referring to the development of in-stent neoatherosclerosis, which focus on the lipid level , composition of stent itself and inflammatory factor,will be assessed .We also want to test the feasibility of preventing the in-stent neoatherosclerosis by specific and nonspecific anti-inflammatory treatments. Our study is aimed to provide imaging criteria for in vivo assessment of in-stent neoatherosclerosis and to provide the preliminary understanding of the mechanism of in-stent neoatherosclerosis.

药物洗脱支架的应用明显减少了冠脉支架内再狭窄，但晚期支架内血栓（LST）会导致急性心肌梗死甚至猝死，已成为临床关注热点。最近冠脉内影像学和人类病理学研究分别报道了支架内新生斑块破裂可能是LST的主要原因之一。但支架内新生斑块的影像学检测与病理相关性如何？其形成和进展的关键影响因素是什么？目前尚不清楚。我们前期工作显示，高脂喂养可诱导兔髂动脉支架内斑块的发生。本研究拟建立兔髂动脉支架内新生斑块模型，应用频域光学相干断层成像（FD-OCT）和虚拟组织学血管内超声成像（iMAP-IVUS）检测支架内斑块的特点，评价影像学手段检测支架内斑块与病理的吻合度。结合分子生物学等检测手段，研究血脂水平、支架自身成分和炎症因素在支架内斑块形成过程中的作用，初步探讨特异性和非特异性抗炎治疗在抑制支架内斑块进展中的作用。本研究拟为影像学在体检测支架内斑块提供依据，为进一步研究支架内斑块发生机制奠定基础。

在过去的 20 多年里，支架治疗心血管疾病取得了巨大的技术进步。虽然随机的临床研究证明使用药物洗脱支架相较于裸支架大大减少了心脏不良事件的发生，但 LST 和VLST 仍然会导致急性冠脉事件。最近 OCT 和血 IVUS 等冠脉内影像学研究和人类病理学研究分别报道了支架内新生斑块破裂可能是 LST 的主要原因之一。最近冠脉内影像学和人类病理学研究分别报道了支架内新生斑块破裂可能是 LST 的主要原因之一。本研究采用高脂喂养可诱导兔颈动脉支架内斑块的发生，建立兔颈脉支架内新生斑块模型，应用频域光学相干断层成像（FD-OCT）和虚拟组织学血管内超声成像（iMAP-IVUS）检测支架内斑块的特点，评价影像学手段检测支架内斑块与病理的吻合度。同时结合病理学研究，探讨影像学手段检测支架内新生斑块的敏感性及特异性高的指标，可建立活体诊断支架内新生斑块的影像学检测体系，为影像学在体准确及时检测支架内新生斑块提供依据。结合分子生物学等检测手段，研究血脂水平、支架自身成分和炎症因素在支架内斑块形成过程中的作用，初步探讨了非特异性抗炎治疗在抑制支架内斑块进展中的作用。本研究拟为影像学在体检测支架内斑块提供依据，为进一步研究支架内斑块发生机制奠定基础，为临床解决此类问题提供思路和方法。

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