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

The role of coronary pressure guide wire in guiding intracoronary stent implantation

Objective We investigated the usefulness of coronary pressure measurement for predicting optimum and suboptimum stent deployment and compared the result with that yielded by using intravascular ultrasound(IVUS).Methods In 51 patients,after stents were implanted,IVUS and coronary pressure measurement were used to evaluate whether optimum results were present.If any of the 2 techniques did not yield an optimum result,the next inflation was performed until optimum stent deployment was present or until the treating physician decided to accept the result.Results Optimum deployment according to IVUS was finally achieved in 41 patients,according to coronary pressure measurement in 45 patients.During the set up,a total of 82 paired IVUS and coronary pressure measurements were performed,of which 90% yielded concordant results(i.e.either an optimum or suboptimum expansion of the stent by both tchniques, P <0.05).According to the combined IVUS criteria,the value of coronary pressure derived myocardial fractional flow reserve(FFRmyo) most predictive for optimum stent deployment was established by receiver operating characteristic curve analysis;the result was 0.90.Conclusion In this study,both IVUS and coronary pressure measurement were of similar value with respect to the assessment of optimum stent deployment.Therefore,coronary pressure measurement can be used as a cheaper and more rapid alternative to IVUS for that purpose.