作者：Pedro A. Lemos, Celso K. Takimura, Francisco R.M. Laurindo, Paulo S. Gutierrez, Vera D. Aiello
单位：巴西 圣保罗市 圣保罗大学医学院 心脏研究所The Heart Institute (InCor), University of S?o Paulo Medical School, S?o Paulo, Brazil
通讯作者：Pedro A. Lemos, MD, PhD.
通讯地址：Instituto do Cora??o-InCor, HCFMUSP, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco I, 3? andar, Hemodin?mica, S?o Paulo-SP 05403-000, Brazil.
Tel: +55 11 3069 5286; Fax: +55 11 3069 5634. Email: pedro.lemos@incor.usp.br.
研究目的： 血管内超声检查（IVUS）和光学相干断层扫描（OCT）这两个方法把新生内膜定义为支架（stent）和管腔边界（lumen boundaries）之间的组织。与此不同的是，传统组织病理学把新生内膜定义为内部弹性层和管腔之间的组织。我们的研究目的是，在针对新生内膜的测量评估中，使用IVUS和OCT等方法、与使用传统的新生内膜病理组织量化方法是否有差异。
研究方法：使用猪冠状动脉植入支架28天后内膜增生模型（n=13裸支架）进行病理组织学研究实验。传统方法定义内膜面积(NIHPATH area)用IEL面积减去官腔面积计算，其中新生内膜容积阻塞率用NIHPATH area除以IEL面积计算。IVUS/OCT及类似方法定义的内膜面积(NIHIVUS/OCT area)用支架面积减去管腔面积计算，其中的新生内膜容积阻塞率用NIHIVUS/OCT area除以管腔面积计算。
研究结果：内膜组织面积以及新生内膜容积阻塞率在使用传统方法和IVUS/OCT类似方法计算时呈现出显著的相关性（R2=0.89 and 0.95 respectively; P<0.01 for both），两种测量方法的平均绝对差值接近于0，但是有一相对较大的离差（dispersion）：新生内膜面积差异0.41 mm2 [95% CI 1.72 to -0.90 mm2]; 新生内膜容积阻塞率差异: 2.5% [95% CI 11.5 to -6.5%]）
研究结果：在使用IVUS和OCT成像技术进行的再狭窄实验模型的内膜参数计算中，目前的研究结果支持将支架面积换成IEL面积进行计算。
关键词：病理学; 再狭窄; 血管内超声; 光学相干断层扫描
英文原文：
A histopathological comparison of different definitions for quantifying in-stent neointimal tissue: implications for the validity of intracoronary ultrasound and optical coherence tomography measurements
Pedro A. Lemos, Celso K. Takimura, Francisco R.M. Laurindo, Paulo S. Gutierrez, Vera D. Aiello
The Heart Institute (InCor), University of S?o Paulo Medical School, S?o Paulo, Brazil
Corresponding to: Pedro A. Lemos, MD, PhD. Instituto do Cora??o-InCor, HCFMUSP, Av. Dr. Eneas de Carvalho Aguiar, 44, Bloco I, 3? andar, Hemodin?mica, S?o Paulo-SP 05403-000, Brazil. Tel: +55 11 3069 5286; Fax: +55 11 3069 5634. Email: pedro.lemos@incor.usp.br.
Abstract
Purpose: Intravascular ultrasound (IVUS) and optical coherence tomography (OCT) define neointima as the tissue encompassed between the stent and the lumen boundaries. This approach differs from the gold-standard histopathology, where neointima is traditionally calculated as the tissue between the internal elastic lamina (IEL) and the lumen. We aimed to investigate whether the neointimal assessment using IVUS and OCT-like definitions would correlate with the traditional histopathological quantification of neointima.
Methods: Histopathological analysis was obtained from a porcine model of 28-day coronary in-stent neointimal proliferation (n=13 bare stents). Traditional histopathology neointimal area (NIHPATH area) was calculated as the IEL area minus the lumen area, while the percent neointimal obstruction was defined as NIHPATH area divided by the IEL area. The IVUS/OCT-like neointima area (NIHIVUS/OCT area) was defined as the stent area minus the lumen area, while the percent neointimal obstruction was defined as NIHIVUS/OCT area divided by the stent area.
Results: The neointimal area as well as the percent obstruction were significantly correlated between histopathology and IVUS/OCT-like definitions (R2=0.89 and 0.95 respectively; P<0.01 for both). The average absolute difference between the IVUS/OCT-like and the pathology-like measurements was close to zero, however with a relatively wide dispersion (difference for neointimal area: 0.41 mm2 [95% CI 1.72 to -0.90 mm2]; difference for percent neointimal obstruction: 2.5% [95% CI 11.5 to -6.5%]).
Conclusions: The present findings support the use of stent area in replacement to IEL area, as in IVUS & OCT imaging protocols, for the calculation of neointimal parameters in experimental model of restenosis.
Key words
Pathology; restenosis; intravascular ultrasound; optical coherence tomography
Cardiovasc Diagn Ther 2011;1:3-10. DOI: 10.3978/j.issn.2223-3652.2011.10.03
