摘要
目的探讨血管内超声在冠心病支架植入中的作用。方法50例患者的52处病变在支架植入前后分别用血管内超声进行定量和定性分析,并根据血管内超声标准决定支架的直径以及植入的终点,分析CAG和IVUS对支架植入终点判断的差异和最终获得的管腔面积大小的差别以及支架后管腔面积增大的机制。结果IVUS比CAG判断的平均支架直径大[(3.48±0.29)mmvs(3.36±0.33)mm,P=0.011],支架囊的最终峰值压力明显增大[(17.7±2.9)atmvs(12.8±2.4)atm,P<0.001],QCA测得的支架面积狭窄百分比减小(13.2%±6.6%vs16.6%±9.1%,P=0.044);首次高压扩张后支架满意率CAG达96.2%,而IVUS只有37.7%。IVUS指导后最终的球囊压力更高[(16.13±1.87)atmvs(12.62±2.61)atm,P<0.001],获得的管腔直径更大[(3.64±0.53)mmvs(3.31±0.57)mm,P<0.001],管腔面积也更大[(9.90±2.05)mm2vs(8.84±1.67)mm2,P<0.001],面积狭窄百分比更小(49.15%±9.03%vs54.24%±10.05%,P<0.001];所有患者支架的近段和远段CAG均未发现明显的狭窄。而IVUS却发现支架近段血管有39例(75.0%),远段血管有23(44.2%)例存在动脉粥样硬化斑块;支架植入后非脂质斑块较脂质斑块获得的管腔面积更大[(4.50±1.67)mm2vs(3.68±0.97)mm2,P<0.001],其中脂质斑块血管面积增大较非脂质斑块小1.30mm2,斑块压缩程度却增加0.48mm2。结论IVUS较CAG能更好地判断病变的性质,指导支架更好地选择,可获得更大的管腔面积,更小的面积狭窄百分比。
Objective To investigate the function of intravascular ultrasound （IVUS） in stent implantation for treatment of coronary heart disease. Methods Qualitative and quantitative analysis was done in 50 coronary artery disease patients with 52 lesions before and after stent implantation. The stent diameter and the end point of therapy determined by IVUS standard. The difference of end point for stent implantation guided by CAG and by IVUS was analyzed and the enlargement of lumen area gained by stent implantation was compared in the two groups, the mechanism of lumen enlargement was analyzed. Results The average stent diameter guided by IVUS was larger than that guided by CAG [（3.48±0.29） mm vs （3.36±0.33） mm, P=0.011], the peak balloon pressure was higher in IVUS group than CAG group [（17.7±2. 9） atm vs （12. 8±2.4） atm, P〈0. 001], and area stenosis percentage measured by quantitative coronary angiogram was smaller in IVUS group than CAG group [（13.2±6.6） % vs （16. 6±9.1%）, P=0.044]. CAG showed the success rate was 96. 2% and IVUS showed the success rate was only 37. 7% after first balloon high-pressure dilation. IVUS subgroup analysis showed the peak balloon pressure was higher [（116.13±1.87） atm vs （12.62±2.61） atm, P〈0. 001], lumen diameter was larger [（3.64±0.53） mm vs （3.31±0.57） mm, P〈0. 001], lumen area was larger [（9.90±2.05） mm^2 vs （8. 84±1.67） mm^2 , P〈0.001], and area stenosis percentage was smaller （49.15% ± 9.03% vs 54.24 % ± 10.05 %, P〈0. 001]. There was no obvious stenosis at proximal and distal segment to the stent observed by CAG, while there were 39 （75.0 % ） atherosclerotic lesions at proximal segment to the stent and 23 （44. 2 %） atherosclerotic lesions at distal to the stent observed by IVUS. The lumen area was larger [（4. 50±1.67） mm^2 vs （3.68±0.97） mm^2 , P〈0. 001] in fatty plaque than in non-fatty plaque after stent implantation. Compared with non-fatty plaque, the enlargement of vessel area was 1.30 mm^2 smaller, while plaque compression was 0.48 mm^2 larger. Conclusion Compared with CAG, IVUS can identified the quality of plaque more precisely and help choose stent more objectively; larger lumen area and smaller area stenosis percentage can be gained under IVUS guidance.
出处
《中国介入影像与治疗学》
CSCD
2007年第1期1-7,共7页
Chinese Journal of Interventional Imaging and Therapy
关键词
血管内超声
冠状血管造影术
支架植入术
冠状动脉疾病
Intravascular ultrasound
Coronary angiography
Stent implantation
Coronary artery disease
