血管内超声在直接支架置入术治疗冠状动脉狭窄的临床研究

目的通过血管内超声(IVUS)指导下对进行直接支架置入术治疗冠状动脉狭窄的可行性及疗效的评价进行临床研究。方法对于42例冠状动脉造影显示为A、B1型病变,小于10mm病变、非严重成角病变(多个弯曲>45°)、非钙化病变的病变血管在IVUS的指导下进行冠状动脉内直接支架置入术。结果所有患者均进行了冠状动脉造影和IVUS检查,并在基础IVUS检查后成功地在狭窄病变部位进行了直接支架置入术。患者的病变术后的前向血流均为TIMI3级,在支架置入后均获得满意的冠状动脉造影结果,残余狭窄<10%,没有出现冠状动脉造影可见的夹层,未出现与IVUS相关的严重并发症。住院期间均未发生主要心血管事件。结论在严格掌握好手术的适应证和禁忌证的情况下,血管内超声指导下进行直接支架置入术比传统冠状动脉造影相比,在选择合适的病变血管、达到最佳的置入效果、节省球囊的使用、成功率和安全性等方面都有明显的优势。

Direct stent implantation for coronary stenosis using intravascular ultrasound imaging

[Objective] To explore the safety and the effection of the direct stent implantation under the intravascular ultrasound imaging guidance. [Methods] The 42 lesions which were of type A or B1, less than 10 mm, non-severe tortuous (more than 45 angulations) and non-calcification by coronary angiography (CAG) had successful direct stent implantation guided by intravascular ultrosound (IVUS) imaging. [Results] All the patients successively undergwent the CAG and IVUS imaging. The forward blood flow was TIMI 3 grade in all culprit lesions after procedure. There was less than 10% residual stenosis, without dissection and coronary artery spasm by CAG after stent deployment. There were not any main cardiovascular events. [Conclusion] In a selected coronary lesion, the selected direct stent implantation without predilatation could be of more optimum effect, balloon-saving, successfully and safely performed by IVUS image than that of CAG.