Abstract
We used optical coherence tomography (OCT) to analyze the "half-moon" like phenomenon and its characteristics and observe 1-year follow-up of the in-stent restenosis (ISR) incidence after the drug eluted stent (DES) implantation in patients with the myocardial bridge (MB). Patients were retrospectively analyzed from January 2013 to December 2019. We used OCT to check 45 patients with MB and found a visible muscle layer (VML) around the vessel adventitia with the same or high density compared to the vessel media layer. There was not any significant difference in maximal thickness, maximal arch, and total length between the half-moon layer and the visible muscle layer groups (p > 0.05). Maximal thickness, arch, and total length of the half-moon layer were significantly positively related to VML, respectively (r = 0.962, 0.985, 0.742, p < 0.01). Of these 626 patients with MB seen by OCT, only 300 could be checked out by coronary angiography (CAG). Besides, the larger the thickness and arch of the VML around the vessel adventitia, the more severe the MB in these patients (p < 0.05). After the OCT use, there was no coronary perforation in these patients with MB covered with DES. After 1-year follow-up, ISR in MB covered with DES showed a notable difference among no MB, mild MB, moderate MB, and severe MB groups (p < 0.05), and ISR in DES aggravated with the MB severity. However, ISR in MB with and without covered with DES had no significant difference among the 4 groups (p > 0.05). OCT could evaluate MB characteristics accurately compared to IVUS and had a higher rate of detecting MB than CAG. Moreover, it is safe and effective to guide DES covering the mild MB segment in patients with severe coronary lesions detected by the OCT.
Highlights
The heart is supplied by the branches of the left and right coronary arteries[1]
IVUS and Optical coherence tomography (OCT) characteristics about myocardial bridge (MB) among no MB, mild MB, and moderate to severe MB groups according to coronary angiography (CAG). 45 patients with MB were detected by the IVUS and divided into no MB, mild
Arch, and total length of the half-moon layer were significantly positively related with those of the visible muscle layer, respectively (r = 0.962, 0.985, 0.742, p < 0.01) (Fig. 4). These results revealed that a visible muscle layer around the vessel adventitia detected by the OCT could accurately reflect the MB condition compared to the IVUS
Summary
The heart is supplied by the branches of the left and right coronary arteries[1]. Because these vessels and their main branches are distributed along the heart surface, they are called epicardial coronary a rteries[2]. Bose et al have first reported a male case with chest pain that OCT showed no evidence of atherosclerosis but did show that the vessels were patent in diastole and collapsed in systole[13] Liu and his colleagues have documented that OCT detected a sharp border and heterogeneous, signal-poor fusiform area indicative of arterial tunneling through the myocardium different from the echolucent muscle layer shown on IVUS in patients with MB14. In the present study, we first found that the visible muscle layer around the coronary artery adventitia using OCT corresponded to the "half-moon" area using IVUS and tested the relation between their characteristics in 45 patients with MB detected by both IVUS and OCT.
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