血管内超声对冠脉内支架植入术的指导和效果评价

目的：应用血管内超声（IVUS）检测技术，探讨其对患者冠状动脉内支架植入术（STENTING）适应症选择、手术过程指导以及手术效果评价中的作用。方法：对71例患者的89处冠状动脉血管段于术前、53处血管段于STENTING后处16处血管段于高压球囊再扩张后进行IVUS检测。将血管的总截面积、管腔面积、斑块面积、面积狭窄率四个指标的术前、STENTING后、高压球囊再扩张后三种状态分别进行配对t－检验。结果：IVUS检测显示需手术干预的病变血管69处。STENTING术后复查IVUS的血管53处，其中效果理想的33处，不理想而需高压球囊再扩张的20处。有16处血管经高压球囊再扩张后，再次复查IVUS显示支架打开理想。统计学分析显示：血管总截面积、斑块面积、管腔面积、面积狭窄率在STENTING前后之间的差异均有显著性。对高压球囊再扩张前后之间的差异，血管总截面积、斑块面积无显著性，管腔面积、面积狭窄率有显著性。结论：IVUS能准确选择STENTING适应症，指导选择支架的大小。STENTING及高压球囊再扩张后，血管总截面积及斑块面积的扩大或缩小，在一定程度之后受到限制。而STENTING后支架打开不理想的血管，经高压球囊再扩张仍可收到一定效果。

Instruction and Effect Evaluation of Coronary Stenting by Intravascular Ultrasound Image

Objective:To study the indications of coronary stenting,instruct the operation and evaluate the effect by intravascular ultrasound (IVUS).Methods:We studied 89 coronary segments of 71 patients before operation,53 segments after stenting and 16 segments after high pressure balloon re expansion by IVUS.The four indexes including the total vessel area(TVA),lumen area(LA),plaque area(PA)and percent area stenosis(PAS)were evaluated with t test individually in pre operation,post stenting and high pressure balloon re expansion groups.Results:Sixty nine segments were indicated for operation by IVUS.Post stenting in 53 segments was checked with IVUS.Thirty three segments had good effect and 20 segments with no ideal effect needed high pressure balloon re expansion,16 segments(16/20)with re expansion were shown good effect by IVUS.Statistic analysis showed IVA,PA,LA and area stenosis rate(ASR)had significantly difference between pre operation and post operation.TVA and PA had no difference,but LA and ASR had obvious difference between pre and post high pressure balloon re expansion.Conclusions:IVUS can be used to select the stenting indication and the size of stenting exactly.The increase and decrease of TVA and PA were limited to some degree after stenting and high pressure balloon re expansion.Post stenting vessels showed bad effect can be im proved some what by high pressure balloon re expansion.