血管内超声在颈动脉狭窄支架成形术中的应用

目的 探讨血管内超声在颈动脉粥样硬化狭窄诊断和评价经皮血管内支架成形术治疗颈动脉狭窄的应用价值。方法 应用血管内超声，对8例经颈动脉B超初选疑诊颈动脉狭窄患者，进行颈动脉内壁病变判断，指导支架植入，并观察血管内支架植入前后血管形态学改变。结果 血管内超声清晰显示血管壁的形态结构，精确测量斑块面积、管腔面积和面积狭窄率。该组8例均接受内支架成形手术，成功置入支架8枚；经3～12个月的随访，除2例于术后30d内短暂性脑缺血(TIA)发作外，无其他病例TIA和脑梗塞再发生。结论 血管内超声应用于判断颈动脉狭窄和病变性质并引导经皮血管内支架成形术精确可靠，弥补了数字减影脑血管造影的不足。     

Relationship between tissue type plasminogen activator and coronary vulnerable plaque in patients with acute coronary syndrome: virtual histological study

Background The association between vulnerability of plaque assessed with intravascular ultrasound （IVUS） and plasma levels of fibrinolytic biomarkers was determined in patients with acute coronary syndrome （ACS）. However, few data are available on the relationship between the levels of tissue type plasminogen activator （t-PA） and virtual histological intravascular ultrasound （VH-IVUS） signs of plaque instability. Methods Eighty-nine patients with ACS were enrolled in the study. Blood was collected to measure t-PA levels by liquid phase bead flow cytometry. Eighty-nine nonbifurcate lesions （identified by coronary angiography and ECG） were investigated using IVUS before catheterization. IVUS radiofrequency data obtained with a 20 MHz catheter were analyzed with IVUS virtual histological software. The areas of plaque and media were calculated and lesions were classified into two groups： VH-IVUS derived thin cap fibroatheroma （VH-TCFA） and non-VH-TCFA plaque. Results Plasma t-PA level in the patients with TCFA was significantly lower than that with non-TCFA （（1489 ± 715） pg/ml vs （2163 ± 1004） pg/ml）. Decreased plasma levels of t-PA were associated with plaque vulnerability. Plasma levels of t-PA correlated negatively with plaque plus media and necrotic core in plaque in patients with ACS. Conclusions t-PA is an independent risk factor and a powerful predictor of vulnerable plaques. Decreased levels of t-PA may reflect instability of atherosclerotic plaques and might therefore serve as noninvasive determinants of those at high risk for consequent adverse events.     

血管内超声用于外周动脉狭窄诊断、治疗的临床价值

目的评价血管内超声(intravascular ultrasound,IVUS)对外周动脉狭窄的诊断和血管内介入治疗的价值。方法选择2006年10月至2010年9月西南医院心内科诊断为外周动脉狭窄的住院患者94例,其中男性58例,女性36例,年龄26~77(58.4±18.3)岁。将患者分为数字减影血管造影(digital subtraction angiography,DSA)组(行DSA检查,43例)及DSA+IVUS组(行DSA及IVUS检查,51例),对2种检查结果进行比较。分别在DSA及IVUS指导下置入支架,并观察支架置入效果。术后采用普通超声、CTA随访,必要时再次行DSA及IVUS检查。结果 DSA+IVUS组中DSA检测发现狭窄血管77处,其中偏心性狭窄42处,向心性狭窄35处;IVUS检测发现狭窄血管82处,其中偏心性斑块63处,向心性斑块19处。直径狭窄率IVUS所测值[(67.1±12.2)%]显著高于DSA[(54.5±11.4)%](P<0.05)。面积狭窄率IVUS所测值[(89.3±12.3)%]显著高于DSA[(77.1±13.1)%](P<0.05)。DSA+IVUS组支架置入治疗82处血管病变,DSA组支架置入治疗53处血管病变,支架置入均获成功。经3~48个月随访,DSA组再狭窄率[15.1%(8/53)]显著高于DSA+IVUS组[3.7%(3/82)(P<0.05)]。结论 IVUS比DSA能更准确地判定病变性质及狭窄程度,更有效地指导和评估支架置入。     

心绞痛患者冠状动脉造影与血管内超声的对比分析

目的：应用选择性冠状动脉造影和血管内超声（IVUS）对心绞痛患者的冠状动脉病变进行临床对比分析。方法：对125名有典型心绞痛的患者进行选择性冠状动脉造影和血管内超声检测，按心绞痛性质分为稳定型心绞痛组（SA组）和不稳定型心绞痛组（UA组），比较两组患者冠状动脉狭窄程度、斑块形态和性质的差异。结果：冠状动脉造影显示的病变血管及狭窄程度两组比较差异无统计意义，但是血管内超声显示，UA组病变以脂质斑块多见，SA组病变则以纤维斑块和钙化斑块多见，UA组病变自发性内膜撕裂和血栓形成的比例明显高于SA组。结论：IVUS对于不稳定型心绞痛患者的冠状动脉粥样硬化斑块病变特点的诊断明显优于冠状动脉造影，对冠状动脉介入手术方案的选择至关重要。     

血管内超声用于颈动脉狭窄诊治的研究

目的 评价血管内超声(IVUS)对颈动脉粥样硬化狭窄的诊断和血管内介入治疗的价值.方法 本院超声检查显示颈动脉狭窄住院患者17例进行选择性颈动脉造影术(CA)和颈动脉IVUS检查,通过IVUS检查了解病变斑块性质与特征及计算病变血管最大狭窄程度,并对这两种检查结果 进行比较.在IVUS指导下支架植入,并观察支架植入前后血管形态学改变.结果 CA检测发现狭窄血管21处,偏心性狭窄9处,向心性狭窄12处;IVUS检测发现狭窄血管22处,偏心性斑块17处,向心性斑块5处.病变最窄处血管直径狭窄率IVUS所测值显著高于CA,分别为(66.9±11.2)%与(53.5±12.4)%,两者比较差异有统计学意艾(P<0.05).病变最窄处血管面积狭窄率IVUS所测值显著高于CA,分别为(89.2±12.9)%与(76.1±13.1)%(P<0.05).颈动脉狭窄支架成形术(CAS)治疗20处血管病变,支架植入均获成功.结论 对于CA显示的狭窄病变,IVUS能更准确地判定管腔形态、病变性质及狭窄程度,更有效地指导和评估支架植入.     

急性冠脉综合征冠脉病变的血管内超声研究

目的 探讨急性冠脉综合征冠状动脉罪犯病变的血管内超声(IVUS)特点.方法 对35例稳定型心绞痛(SA)患者和49例急性冠脉综合征(ACS,包括急性心肌梗死和不稳定型心绞痛)患者进行冠状动脉造影(CAG)检查,并应用IVUS观察冠脉罪犯病变处的粥样硬化斑块的性质,同时测量血管外弹力膜面积(EEA)、管腔面积(LA),计算斑块面积(PA)、斑块负荷、偏心指数(EI),并观察血管重构情况.结果 ACS患者冠脉病变处以软斑块为主(69.4%,34 /49) , SA患者冠脉病变处以硬斑块为主(77.1%,27/35) ,差异有统计学意义(P＜0.05),其中ACS组不稳定斑块、内膜破裂和血栓形成病变占总病变的57.2%,与SA组(8.6%)相比具有显著差异性(P＜0.01);同时两组患者斑块面积[(11.26±3.92) mm2 vs (9.43±3.98)mm2],斑块负荷[(65.67±11.74)% vs(57.34±11.18)%],偏心指数(0.33±0.22 vs 0.59±0.24)相比差异亦具有显著性(P＜0.01);而且,ACS患者主要以正性重构为主(59.2%),而SA患者主要以负性重构为主(57.1%),二者均有统计学差异(P=0.000,P=0.002).结论 在ACS组不稳定斑块及内膜破裂、血栓形成、血管正性重构发生率明显高于SA组,IVUS检查是在体观察粥样斑块的良好手段,并可以指导治疗策略.     

血管内超声对易损斑块评估的研究进展

确定易损斑块的诊断技术正在迅速发展中。血管内超声(IVUS)能够检测和明确斑块的位置以及定量测量斑块负荷。现在正在应用新的IVUS相关技术来评估斑块破裂之前的易损性。最初,IVUS主要用于定性钙化斑块或纤维脂肪斑块,但它在检测脂质丰富的斑块、坏死核心以及血栓方面的能力有限。血管内超声应用方面的最新进展,如逆向散射、小波分析及虚拟组织学侧重于评估和数字转换射频信号,将超声波信号转换成彩色编码从而代表斑块的特点如脂肪、纤维组织、钙化和坏死核心。此外,弹性图利用腔内压力造成其变形的力学性能评估局部组织,因此在评估存在脂质池,并确定高应变区域,血管内超声弹性图可能是一个理想的技术。     

Multiple coronary aneurysms in a patient with neurofibromatosis type 1: case report and intravascular ultrasound of aneurysm

A 54 year old woman with neurofibromatosis type 1 (NF-1) was found to have multiple coronary aneurysms. Intraoperative intravascular ultrasound (IVUS) revealed severe coronary disease proximal to the aneurysm that had not been apparent angiographically. An IVUS picture of one of the giant coronary aneurysms is also shown. The vascular manifestations of neurofibromatosis and the causes of coronary aneurysms are reviewed.     

轻中度狭窄病变血管内超声影像学特征与超敏C反应蛋白的关系研究

目的 探讨冠状动脉轻中度狭窄病变斑块超声影像学特征与血清超敏C反应蛋白的关系.方法 78例冠心病患者分为轻中度狭窄组(62例)和重度狭窄组(16例),对两组患者靶血管内超声特征与血清超敏C反应蛋白进行相关研究.结果 轻中度狭窄组血管内超声检出脂质斑块51例82.26%(51/62),其病变的血管外弹力膜面积(EEMA)、斑块面积(PA)及管腔面积狭窄率(LAS)、重构指数(RI)明显大于重度狭窄组,差异有显著性意义(均P＜0.05).两组间在纤维帽厚度、脂核或无回声带大小、脂核与斑块比存在统计学差异.血清超敏C反应蛋白与EEMA、RI呈正相关.结论 易损斑块为偏心分布的低回声脂质斑块,具有较大的斑块面积和明显的正性重构;血清超敏C反应蛋白可望作为冠脉斑块易损性预测的参考指标.     

血管腔内超声对冠状动脉造影显示的临界病变介入治疗的价值

目的探讨血管腔内超声显像(IVUS)在冠状动脉造影(CAG)显示的临界病变介入治疗中的临床应用价值。方法54例冠心病患者应用IVUS检测到62处病变血管的总截面积(TVA)、最小管腔截面积(MLA)、面积狭窄百分比(%AS)、参照血管直径(RLD)、血管直径(VD)、最小管腔直径(MLD)及直径狭窄百分比(%DS),并测量相应CAG所显示的RLD、MLD、%DS和%AS。根据IVUS检查结果按是否行介入治疗进行分组,介入组26例30处病变和非介入组28例32处病变。介入组检测支架置入前后的上述检测指标。结果CAG显示的MLD、%DS和%AS均低于IVUS的检测值(P<0.05);CAG仅显示管腔外在形态学变化,IVUS则能明确显示斑块的性质及病变的严重程度。介入组平均面积狭窄率为71.4%,符合介入治疗指征,与非介入组的39.6%相比差异有统计学意义(P<0.05);同时,应用IVUS观察了介入组置入支架前后测值变化,除TVA、VD无明显变化外,其余的MLA、%AS、MLD及%DS指标差异均有统计学意义(P<0.05)。结论对CAG显示的临界病变行IVUS检查可了解血管壁内在组织形态学变化和病变程度,实时指导治疗方案的选择和手术过程,其效果优于CAG。     

血管内超声成像的临床应用价值

目的 通过前瞻性临床研究,探讨血管内超声成像（IVUS）的临床应用价值。方法 437例冠心病或可疑冠心病患者同时行冠脉造影（CAG）和IVUS检查,包括135例CAG正常者的IVUS检查结果,52例介入治疗前后CAG和IVUS的比较,150例钙化病变CAG和IVUS比较及47例IVUS、53例CAG引导支架置入的心脏事件比较。结果 IVUS能发现CAG正常患者的冠状动脉继样硬化病变。CAG会高估冠状动脉腔内成形术（PTCA）介入效果。与CAG比较,IVUS能比较准确地判断介入治疗的效果及其并发症,并可阐明PTCA的机制,IVUS引导支架置入显著减少心脏事件的发生。结论 IVUS与CAG的区别在于冠脉造影只能显示冠状动脉腔的造影剂轮廓;而IVUS则显示了绝然不同的血管解剖,通过血管截面积成像识别血管内膜腔及管壁的结构,IVUS在引导冠心病的介入治疗中也具有重要作用。     

Identification of syndrome X using intravascular ultrasound imaging and Doppler flow mapping

Background The purpose of this study was to assess the morphological changes and physiological function of coronary arteries in patients presenting with chest pain but having normal coronary angiograms, using intravascular ultrasound imaging (IVUS) and intracoronary Doppler (ICD) flow measurements, in order to elucidate the mechanism of syndrome X. Methods A total of 126 patients ［67 males, 59 females, mean age (53.1±13.0) years］ who experienced chest pain but had normal coronary angiograms were included in this study. ICD flow measurements of the left anterior descending coronary artery (LAD) were performed using a Cardiometrics FloMap Ⅱ system. Coronary flow velocity reserve (CFVR) was defined as the ratio of the average peak velocity during hyperemia to that at baseline, induced by an intracoronary bolus injection of 18 μg adenosine. A 3.2F or 2.9F 30 MHz mechanical rotating ultrasound catheter (CVIS, Boston Scientific) or a 3.0F 20MHz electronic ultrasound catheter (Endosonics) was used for IVUS. Results The mean CFVR value of the LAD was 2.71±0.74. Reduction of CFVR (&lt;3.0) was found in 82 of 126 (65.1%) patients. IVUS images of the LAD were available for 109 patients. Plaque formation was detected in 76/109 (69.7%) patients. Based on the presence or absence of plaque formation as well as the reduction or non-reduction of CFVR, patients were divided into four groups: Group Ⅰ (n=10), normal IVUS findings and normal CFVR; Group Ⅱ (n=23), normal IVUS findings with reduction in CFVR; Group Ⅲ (n=29), IVUS evidence of plaque formation but normal CFVR; and Group Ⅳ (n=47), IVUS evidence of plaque formation with reduction in CFVR. Conclusion This study shows the important clinical value of a combination of IVUS and ICD in diagnosing patients with angiographically normal coronary arteries. Only 10% of patients studied (Group Ⅰ) were found to be truly free of coronary disease, while 20% of patients (Group Ⅱ) would be diagnosed as suffering from syndrome X.     

血管内超声在动脉粥样硬化性肾动脉狭窄筛查中的价值

目的：探讨血管内超声筛查动脉粥样硬化性肾动脉狭窄的价值。方法：选取行肾动脉造影的患者,进一步进行血管内超声检查,观察肾动脉斑块的特点,比较肾动脉造影与血管内超声检查结果之间的相关性,探索血管内超声检查是否增加X线曝光时间。结果：在动脉粥样硬化性肾动脉狭窄的患者中,血管内超声检查可以获得稳定的肾动脉全程图像,能描述肾动脉斑块的解剖学信息,血管内超声扫查结果与造影结果具有良好的相关性,能发现造影所不能发现的问题,可以作为肾动脉造影的重要补充,血管内超声检查未显著增加术中X线暴露时间。结论：血管内超声可以实现动脉粥样硬化性肾动脉狭窄的常规筛查,是肾动脉造影的重要补充,不显著增加X线暴露时间。     

冠状动脉中度狭窄病变的血管内超声显像特征及价值

目的 通过血管内超声显像(IVUS)研究,了解冠状动脉造影(CAG),提示冠状动脉中度狭窄病变的性质及狭窄程度,为临床治疗方案的选择提供决策依据.方法 对经CAG发现冠状动脉存在中度狭窄的36例患者47处病变进行IVUS检查,观察病变斑块性质、特征和血管最大狭窄程度,并对CAG和IVUS两种检查结果 进行比较.结果 CAG不能显示管腔形态及斑块特点,CAG发现偏心性狭窄13处,向心性狭窄34处,病变最窄处血管直径狭窄率为(45.24±12.1)%;IVUS检测发现偏心性斑块38处,向心性斑块9处,不稳定斑块29处.IVUS所测病变最窄处直径狭窄率为(56.37±11.2)%(CAG,P<0.05),血管面积狭窄率为(79.51±15.5)%,行冠脉内支架植入31处.结论 中度狭窄病变多为不稳定易损斑块,IVUS可准确地判定冠状动脉的病变性质和狭窄程度,更好地指导临床确定治疗策略.     

冠状动脉临界病变介入与药物治疗的预后比较

目的:比较冠状动脉临界病变行冠状动脉介人治疗(PCI)与药物治疗的预后.方法:选择上海中医药大学附属普陀区中心医院心内科2010年1-12月经冠状动脉造影检查证实为冠状动脉临界病变的患者79例,男44例,女35例.采用血管内超声(IVUS)定量测量,最小管腔面积(MLA)<4 mm2(非主干病变)或斑块负荷≥60%的患者接受PCI及常规药物治疗(介人组,42例),MLA≥4 mm2(非主干病变)或斑块负荷<60%的患者只接受药物治疗(药物组,37例).比较两组住院及随访期间主要不良心脏事件(MACE)的发生情况,包括不稳定性心绞痛、心肌梗死、心力衰竭、缺血性靶血管血运重建、死亡.结果:所有患者随访6-12个月.平均随访时间为(8.1±2.4)个月.随访期间,介人组心绞痛发生率、再次行PCI率均为7.1%(3/42),与药物组(均为5.4%,2/37)的差异无统计学意义(P值均＝1),结论:对于冠状动脉临界病变,在合适的技术指导下,合理地选择PCI和药物治疗,均可使患者受益.     

Intracoronary stent implantation under intracoronary ultrasound guidance with aspirin and ticlopidine therapy

Objective To observe the immediate angiographic and intravascular ultrasound (IVUS) result s and their effects on one month clinical outcomes in forty-one patients who su bmitted to coronary stent deployment with IVUS guidance. Methods All patients were allocated to coronary stent implantation with high inflation p ressure. After good angiographic results (&lt;20% residual stenosis), all patients underwent IVUS and higher-pressure dilatation would be necessary if criteria f or optimal coronary stent implantation were not met. The optimal criterion of I VUS for stent implantation was the ratio of intrastent lumen cross-sectional ar ea to the average of the proximal and distal reference lumen cross-sectional ar eas ≥80%. All patients had aspirin and ticlopidine therapy on the day of a ngioplasty and during the one month follow-up period. Results Optimal criteria of IVUS were obtained without any further intrastent dilatation in twenty-five patients but intrastent higher-pressure dilatation was perform ed in fourteen patients whose ultrasound results did not reach the criteria. In these patients, we increased the minimal intrastent lumen area 25.7% (P&lt; 0.05). Thirty-five patients (90%) had good minimal intrastent lumen area of IVUS. There were no deaths, myocardial infarction, acute stent thrombosis or n eed for revascularization during the study and the one month follow-up. Conclusions Intracoronary stent deployment under IVUS guidance, including combining aspirin and ticlopidine therapy, had beneficial ultrasound results and good clinical out comes after one month follow-up.     

血管内超声和血流储备分数测定在冠状动脉临界病变治疗中的作用

目的 比较血管内超声检查(IVUS)和血流储备分数测定(FFR)在指导冠状动脉临界病变治疗中的临床效果.方法 将94例行冠状动脉造影提示冠状动脉临界病变的患者分为IVUS组和FFR组,分别接受IVUS或FFR检查,并以此为依据指导冠状动脉介入治疗.在IVUS组中,如MLA＜4 mm2或冠状动脉狭窄虽不足,但IVUS显示为不稳定斑块,则行冠状动脉介入治疗(PCI);在FFR组中,以FFR＜0.75作为行冠状动脉支架置入术的指征.术后随访6个月,比较两组患者心血管不良事件的发生情况.结果 (1)两组患者病史等一般信息及冠状动脉造影情况差异无统计学意义(P＞0.05).(2) IVUS组行介入治疗的比例高于FFR组(P＜0.01).(3)两组间不良事件的发生情况差异无统计学意义(P＞0.05).结论 IVUS和FFR检查均可用于指导冠状动脉临界病变的介入治疗,受准确性的限制IVUS不能取代FFR检查的地位.     

急性冠脉综合征的血管内超声研究

目的:探讨急性冠脉综合征(ACS)易损斑块的血管内超声(IVUS)特点。方法:在35例ACS(其中不稳定性心绞痛24例,急性心肌梗死11例)和23例稳定性心绞痛患者中进行冠状动脉IVUS检查,测量病变部位的血管外弹力膜面积(EEMA)、斑块面积(PA)及斑块负荷(PA),并计算斑块的偏心指数(EI)及血管的重构指数(RI)。结果:在58例患者中发现,16例ACS患者和5例稳定性心绞痛患者发生斑块破裂;与稳定性心绞痛组比较,不稳定心绞痛的斑块具有较大的偏心性(P<0.05),EEMA、PA、PB、RI明显大于前者,具有显著的统计学意义(P均<0.001)。结论IVUS能够准确地识别ACS易损斑块及其破裂和血栓形成。     

The Impact of the Acute Results on the Long—Term Outcome after the Treatment of In—stent Restenosis：A Serial Intravascular Ultrasoun Study

Stenting reduces acute complications and restenosis compared to balloon angioplasty and other devices. However, in- stent restenosis (ISR) is an important clinical problem. The current serial intravascular ultrasound (IVUS)analysis was undertaken to determine whether the acute results obtained during the treatment of ISR influence the long term results and whether this is true for patients treated with and without adjunct brachytherapy.     

压力导丝在冠状动脉内支架置入中的意义

目的　通过与血管内超声 ( IVUS)相比较 ,探讨压力导丝在评价冠脉内支架置入即刻效果 ,指导优化支架置入中的作用。方法　 5 1例患者置入冠脉内支架后先后予血管内超声和压力导丝检测判断是否达到相应的理想支架置入标准。若未达标准 ,则进一步采用更高压力同样球囊或更大球囊再扩张。结果　支架置入后 IVUS判断 3 1例达到标准 ,不需再扩张 ,15例不满意者再扩张支架 ,支架内截面积增加 2 4 .3 % ( P<0 .0 5 ) ,最终 4 1例 ( 89% )得到满意 IVUS,5例因超声导管未跨过支架无超声资料 ;压力导丝检测 3 5例达到标准 ,不需再扩张 ,16例不满意者再扩张支架最终 4 5例 ( 88% )得到满意结果 (心肌部分血流储备 ,FFRmyo>0 .90 )。血管内超声和压力导丝两者在判定理想支架置入方面有很好的相关性 ,符合率达 90 %。以血管内超声检测作金标准 ,应用受试者工作特性曲线 ( ROC)计算心肌部分血流储备 FFRmyo预测理想支架置入的最佳临界点为 0 .90。结论　压力导丝是指导冠脉支架置入更方便、安全的有效手段 ,有广泛推广应用的价值