血管内超声技术在介入治疗左主干病变中的应用价值

目的 评价血管内超声显像(IVUS)在介入治疗左主干病变中的应用价值.方法 对左主干病变63例患者进行IVUS检查,根据IVUS面积狭窄率进行分组,IVUS面积狭窄率I>50%为介入治疗组(33例)及IVUS面积狭窄率<50%为对照组(30例).介入治疗组采取介入干预治疗;对照组采取常规药物治疗.观察IVUS面积狭窄率及斑块的特征,并进行随访观察并发症.结果 介入治疗组斑块性状以软斑块及偏心性斑块为主,介入治疗中无明显的并发症,随访1年,介入治疗组再发心绞痛4例(12.1%).对照组发生再发心脏事件18例(60.0%),其中发生心绞痛6例,阵发性室速5例,急性心肌梗死3例(均行IVUS,显示左主干为罪犯血管),频发室性期前收缩3例,猝死1例.2组患者心脏事件发生率比较差异有统计学意义(x2=13.81,P<0.01).结论 IVUS对左主干的狭窄程度及指导介入治疗有一定的价值,对IVUS面积狭窄率≥50%的病变进行介入治疗预后良好.

Abstract：

Objective To evaluate the clinical application value of intravascular ultrasound(IVUS) in the treatment of left main coronary stenosis. Methods Sixty-three patients with left main coronary stenosis were identified by IVUS to evaluate the plaque characteristics and the severity of the stenosis. According to the severity of the stenosis,the patients were divided into percutaneous coronary intervention ( PCI) group (IVUS=50% ) (n = 33 ) and control group (IVUS < 50% ) (n = 30). The group of PCI was treated by PCI. The control group was treated by routine therapeutic agents. The profiles of plaques and stenosis were described. The complications were recorded by follow-up visits. Results More soft and eccentric plaques were found in PCI group. After one year follow up,cardiac events (angina) occurred in 4 cases (12. 1% ) in PCI group. In control group, cardiac events ocurred in 18 patients (60. 0%), including 6 cases of angina, 5 case of paroxysmal ventricular tachycardia,3 cases of myocardial infarction (confirmed by IVUS,showing that the left main coronary artery was responsible for the event), 3 cases of frequent premature ventricular contraction and 1 case of sudden death. There was a significant difference in the occurrence rate of cardiac events between PCI group and non-PCI group (x2 = 13. 81 ,P <0.01). Conclusion IVUS is useful for the identification and treatment guidance. Intervention therapy produces good prognosis in patients with IVUS-identified left main coronary stenosis by more than 50% of the area.     

急性冠状动脉综合征参考段血管病变对血管内超声评估冠状动脉重构的影响

目的 探讨急性冠状动脉综合征(ACS)患者参考段血管病变对血管内超声(IVUS)评估冠状动脉重构的影响.方法 对103例ACS患者行常规冠状动脉造影,IVUS检测103个靶病变和参考段血管处动脉粥样斑块形态学参数.重构指数(RI)为病变部位外弹力膜(EEM)面积与近端参考段EEM面积之比,RI>1为正重构(67例),RI≤1为负重构(36例).分析重构分组之间的斑块形态学特点,比较各参数在远端与近端参考段血管之间的差异和相关性.结果 仅1例患者未见参考段血管的病变.正性与负性重构组103处靶病变以及102处参考段血管位点问斑块负荷、管腔面积和EEM面积差异无统计学意义;与远端参考段血管比较,斑块负荷在近端参考段显著增加[(39.76±12.54)%对(32.38±3.97)%,P<0.001],斑块面积也明显增大[(6.14±3.20)mm2对(4.75±3.07)mm2,P=0.001].EEM面积在远端参考段扩增明显高于近端参考段[(14.99±4.12)mm2对(28.37±4.48)mm2,P<0.001].斑块负荷、斑块面积和管腔面积在近端与远端参考段之间均有显著正相关性(均为P<0.05).结论 ACS患者参考段血管弥漫性病变可能影响IVUS冠脉重构的评估;重构是一个动态过程,静态与系列方法结合评估冠脉重构可能更为准确.

Abstract：

Objective To investigate the influence of atherosclerotic reference segments on coronary remodeling by intravascular ultrasound(IVUS) in patients with acute coronary syndrome(ACS). Methods One hundred and three consecutively enrolled patients [male 68 cases,female 35 cases,average age (60 ±11) years] with ACS were undergone by coronary artery angiography and IVUS with time selecting operation. The remodeling index(RI) was defined as lesion external elastic membrane cross section aere (EEM CSA) divided by the mean reference EEM CSA at the culprit vessel. Positive remodeling was RI≥ (67 cases), negative remodeling was RI <1(36 cases). The parameters of plaque were analysed between two remodeling groups, as well as compared between distal and proximal references. Results Only one patients do not have plaque at reference sites. In the analysis of 103 lesions and 102 reference sites, there were not significant different in plaque burden,plaque CSA,lumen CSA and lesion EEM CSA between two groups. Distal plaque burden[(39. 76 ±12. 54)% vs (32.38 ± 13.97)%, P <0.001] and plaque CSA [(6.14 ± 3.20)mm2 vs (4. 75 ± 3. 07) mm2, P = 0. 001] were larger than those at proximal reference. EEM CSA at distal reference was smaller than proximal one[(14. 99 ± 4. 12)mm2 vs (28. 37 ± 4. 48)mm2 , P <0. 001]. Plaque burden, plaque CSA and lumen CSA persented positive corelation between distal and proximal reference sites. Conclusions The reference segments lay a severe diffuse atherosclerosis in the group of ACS, which may influence assessment of coronary remodeling. Coronary remodeling as a process, a accurate evaluation could be result from the combination of static and serial approach by IVUS.     

超声造影评价颈动脉粥样硬化斑块的新生血管及其他危险因素与急性冠状动脉综合征的关系

目的 应用实时超声造影技术评价颈动脉粥样硬化斑块新生血管及其他危险因素与急性冠状动脉综合征(ACS)的关系.方法 冠心病伴颈动脉粥样斑块患者128例,斑块厚度均＞2.0 mm.其中ACS组63例,稳定型冠心病组(Scad)组65例.行颈动脉常规超声及超声造影检查,通过肉眼观测及定量分析斑块造影增强情况,并对受检者进行血液生化指标的检测.结果 肉眼观察,ACS 组造影增强比例(62%,39/63)明显高于Scad组(37%,24/65)(P<0.001).定量分析显示,ACS 组斑块增强强度显著高于Scad组(P=0.001);ACS 组斑块增强强度与颈动脉管腔内增强强度比值(ratio)高于Scad组 (P=0.035).Logistic回归分析显示,年龄＞65岁和颈动脉粥样斑块造影增强是ACS发生的独立危险因素(OR=2.630,95%CI 0.933-7.409,P=0.006;OR=2.687,95%CI 1.002-8.025,P=0.047).结论 年龄＞65岁和颈动脉粥样斑块造影增强可作为预测ACS发生的独立危险因素.

Abstract：

Objective To evaluate the relationship between carotid plaque neovascularization and other cardiovascular risk factors and acute coronary syndrome(ACS) using contrast-enhanced ultrasound.Methods The study population consisted of 128 patients with coronary heart disease associated carotid plaque thicker than 2.0mm,including 63 patients with ACS and 65 patients with stable coronary artery disease (sCAD).Contrast-agent enhancement in the plaque was evaluated by visual interpretation and quantitative analysis.All blood samples of the patients were sent to the same hospital laboratory for biochemical detection and correction.Results The percentage of contrast-agent enhancement in patients with ACS was significantly greater than that in patients with sCAD by visual interpretation [63%(39/63) vs 37%(24/65),P<0.001].The quantitative analysis showed that the enhanced intensity in the plaque and the ratio of enhanced intensity in the plaque to that in the carotid artery lumen in patients with ACS were significantly greater than those in patients with sCAD (P=0.001,P=0.035,respectively).Logistic regression analysis revealed that age older than 65 years and contrast-agent enhancement within plaque were independent predictor for patients with ACS(OR=2.630,95%CI 0.933-7.409,P=0.006;OR=2.687,95%CI 1.002-8.025,P=0.047).Conclusions Age older than 65 years and contrast-agent enhancement in the carotid plaque may be used as independent predictors for ACS.     

药物洗脱支架内再狭窄的危险因素分析

目的 探讨冠状动脉药物洗脱支架内再狭窄的危险因素.方法 对157例行冠状动脉药物洗脱支架植入术患者的临床资料进行回顾性分析,按照冠状动脉造影结果分为再狭窄组33例和无再狭窄组124例,采用单因素及Logistic多因素回归分析其临床及冠状动脉造影特征与药物洗脱支架内再狭窄的相关性.结果 再狭窄组33例,糖尿病18例(54.5%),术后反复心绞痛26例(78.8%);无再狭窄组124例,糖尿病31例(25.0%),术后反复心绞痛72例(58.1%),组间差异有统计学意义(χ2=10.60,P＜0.01;χ2=4.77,P=0.03).2组慢性完全闭塞分别为11例(19.3%)、12例(7.6%),分叉病变12例(21.1%)、16例(10.2%),弥漫病变15例(26.3%)、19例(12.1%),组间差异有统计学意义(χ2值分别为5.92、4.34、6.32,P均＜0.05).再狭窄组植入支架57枚,无再狭窄组植入157枚.Logistic多因素分析显示糖尿病、术后反复心绞痛、慢性完全闭塞、分叉病变、弥漫病变和支架长度与支架内再狭窄相关(OR分别为3.52、2.59、3.05、3.14、3.08、0.93,95%CI分别为1.56～7.90,1.02～6.59,1.11～8.36,1.30～7.59,1.34～7.05,0.88～0.98,P均＜0.05).结论 冠状动脉药物洗脱支架植入术后,糖尿病史、术后反复发生心绞痛、慢性完全闭塞、分叉病变、弥漫病变及支架长度为支架内再狭窄的危险因素.

Abstract：

Objective To investigate the risk factors of in-stent restenosis (ISR) after coronary implantation of drug-eluting stent Methods One hundred and fifty-seven patients including 118 males and 39 females,who underwent successful implantation of drug-eluting stent, were recruited in the study. The patients were divided into the restenosis group (33 patients) and non-restenosis group ( 124 patients) according to the angiographic results. The associations of ISR with clinical and coronary angiographic characteristics were analyzed using univiriate analysis and logistic regression. Results In the restenosis group,there were 18 cases of diabetes mellitus ( 54. 5% ), 26 cases of frequency angina ( 78. 8% ), which were significantly higher than those of 31 cases of diabetes (25.0%) and 72 case of frequent angina (58. 1% ) in the non-restenosis group (χ2 = 10. 60, P ＜ 0. 01, χ2 = 4. 77, P = 0. 03 for diabetes mellitus and frequent angina, respectively). Compared to non-restenosis group, the occurrence rates of chronic total occasion, bifurcatus lesions, diffuse lesions were significandy higher in the restenosis group ( 19. 3% vs 7. 6% χ2 =5.92,21.1% vs 10. 2% χ2 =4. 34,26. 3%vs 12. 1% χ2 =6. 32,Ps ＜0. 05). Fifty-seven stents were implanted into the restenosis group,and one hundred and fifty-seven into the non-restenosis group. Logistic regression analysis showed that diabetes, frequent angina,chronic total occlusion lesions, bifurcatus lesions, diffuse lesions, stent length and diameter were significantly associated with restenosis ( OR value were 3.52,2. 59,3.05,3. 14,3.08,0. 93,95% CI were 1.56 - 7.90,1.02 - 6. 59,1.11 - 8. 36,1.30 - 7.59,1.34 - 7.05,0. 88 - 0. 98 respectively, Ps ＜ 0. 05 ). Conclusion After implantation of drug-eluting stent, diabetes mellitus, chronic total occasion lesions, frequent angina, diffuse lesions, bifurcatus lesions and stent length and diameter are associated with follow-up restenosis.     

Rescue treatment and follow-up intervention of a left main acute myocardial infarction with typical carina shift under 3D optical coherence tomography: A case report

BACKGROUND Coronary intervention for bifurcation lesions is still challenging for interventional cardiologists.Left main(LM)bifurcation lesions have a higher risk due to the vast blood supply in this area and treatment choice is difficult.Ostial compromise of the side branch decreases patient prognosis,and its management is still an issue despite the different strategies and devices available.CASE SUMMARY A 42-year-old male patient was admitted to hospital due to chest pain and syncope.Coronary angiography showed acute LM occlusion.Following thrombus aspiration,a LM bifurcation lesion remained.Coronary angiography was repeated one week later,and at the same time,3D optical coherence tomography(OCT)was carried out to better show the geometry of the bifurcation,which confirmed that the stenosis in the ostial left circumflex artery was caused by a long carina.After assessment of the plaque characteristics and the minimum lumen area,the cross-over strategy,kissing balloon inflation and proximal optimization technique were chosen to treat the bifurcation lesion.A“moving”carina was found twice during the intervention.Good stent apposition and expansion were confirmed by OCT after proximal optimization technique.The three-month follow-up showed good recovery and normal cardiac function.CONCLUSION 3D-OCT can facilitate decision-making for coronary interventions in patients with critical bifurcation lesions.     

Hepatoid adenocarcinoma of the stomach: Thirteen case reports and review of literature

BACKGROUND The aim of the present study was to examine the clinical characteristics of hepatoid adenocarcinoma of the stomach (HAS) and its diagnosis,treatment,and prognosis.CASE SUMMARY A retrospective analysis of 13 HAS cases was performed.The mean age of the 13patients was 66.08 years,and 10 of the 13 patients were male.Prior to treatment,the alpha-fetoprotein levels in the serum were elevated in 7 patients,the tumour was located in the distal or gastric body in 11 patients,and the gastroscopy pathological results showed that 3 patients had poorly differentiated tumours and that 8 patients had moderately/poorly differentiated tumours.Abdominal CT scans showed local stomach wall thickening,and enlarged lymph nodes were visible around the stomach in 8 patients.Of the 13 patients,11 underwent radical surgery.The clinical pathological staging was as follows:Stage Ⅱ in 2 cases;stage Ⅲ in 8 cases;and stage Ⅳ in 1 case.A total of 3 patients were lost to follow-up.Otherwise,as of the last follow-up,3 patients had survived for 56 mo,and the other 7 patients failed to achieve long-term survival (survival period of 1-56 mo).CONCLUSION HAS is a special type of gastric cancer,and the prognosis of HAS has improved compared with past prognoses.Measurement of alpha-fetoprotein,early diagnosis,active surgical treatment,and application of new diagnostic and treatment techniques are conducive to improving the prognosis of HAS.     

aVR导联QRS波形态对下壁心肌梗死的鉴别诊断意义

Objective To investigate the value of differential diagnosis of the configuration of QRS complex in lead aVR in patients with inferior wall myocardial infarction. Methods The configuration of QRS in 52 patients with pathological Q-wave both in lead Ⅲ and aVF were analyzed and the result of selective coronary arteriography was compared. Results 13 patients with the configuration of QRS in lead aVR appeared rS ( s), while 10 patients appeared QS(qs) and 29 Q(q)r,correlated with 12,4 and 0 patients with coronary arteriography showed stenosis or occlusion lesion in fight coronary artery or left circumflex artery (χ2 = 35.56, P = 0.000). Conclusions The con-figuration of QRS in lead aVR is helpful to differential diagnosis of the patients with pathological Q-wave both in lead Ⅲ and aVF. Patients with the configuration of QRS in lead aVR appear rS(s) could be diagnosed as old myocardial infarction,but excluded from old myocardial infarction while appearing Q(q)r.     

医用智能控温仪对蛛网膜下腔出血患者神经功能恢复的疗效观察

1 Subject and method 1.1 Subject 121 SAH patients treated in our department from January 1996 to August 2001 were chosen, 93 male cases and 28 female cases with ages from 35 to 55 and the average age of (43.0± 3.2), they were all taken in hospital in 72 hours after first attack and they were all accorded with the standards set in the 2nd national cerebral vessels academic conference of 1996. the scores were 35～ 45 and they were conformed with CT or MRI, the cerebrospinal fluid showed positive result and there were no other severe compliments, the relatives were willing to take YZK treatment.     

经桡动脉行冠状动脉介入治疗的临床分析

目的 探讨经桡动脉行冠状动脉介入治疗的效果.方法 回顾性分析我院189例经桡动脉介入治疗患者的临床资料.结果 189例患者均经桡动脉入路进行穿刺置管,成功176例(93.12%).13例因桡动脉严重痉挛经注射硝酸甘油、利多卡因、维拉帕米仍无法送管而改为股动脉入路完成介入治疗.桡动脉狭窄3例,术后除10例发生局部手臂肿胀、6例因桡动脉压迫器压迫出现水泡外,无急性冠状动脉闭塞、动静脉瘘、上肢缺血、手神经损伤、大出血等并发症发生.结论 经皮桡动脉穿刺行冠状动脉造影术及介入治疗,成功率高,并发症少,值得在临床推广应用.

Abstract：

Objective To observe the clinical effect of transradial approach for coronary intervention. Methods The clinical data of 189 patients accepted transradial coronary intervention were analyzed retrospectively. Results Transradial catheterizations were performed in 189 patients, while 176 cases had satisfying result, the success rate was 93. 12%. Thirteen patients had severe spasticity in radial artery, which could not be released from injection of nitroglycerin, lidocaine, verapamil, alternatively they accepted transfemoral artery coronary intervention. After the operation 3 cases had radial artery stricture, 10 cases had local ann swelling,6 cases had blisters from the device oppression. No acute coronary occlusion, arteriovenous fistula, upper limb ischemia, hand nerve damage, bleeding or other complications were observed in the cases enrolled. Conclusion The transradial approach for coronary angiography and intervention showed high success rate, few complication, indicating good clinical application promise.     

Factors affecting treatment for platform fracture of tibia

64 cases of tibia platform fracture were received and treated from February1994 to December 2000. The patients were guided for rehabilitation treatment as early function exercise and herb washing esc, the effects were satisfactory and it is reported as following. 1 Objects and methods 1.1 Objects 64 cases,39 male,25 female, aged 16～72 years, 35 cases were at the left and 29 were at the right. 52 cases were treated in one week and 12 were from one week to two weeks.The fractures were of t…     

造影正常冠状动脉左主干的血管内超声研究

目的 探讨冠状动脉造影正常左主干的血管内超声特征.方法 选取冠状动脉造影显示单纯左前降支或左回旋支病变而左主干正常同时行血管内超声(IVUS)检查的76例患者.应用IVUS测量病变部位的斑块负荷,确定斑块的性质.同时确定左主干是否存在病变,若存在病变则确定病变性质;测量左主干的管腔直径和面积以及血管直径和面积;对存在动脉粥样硬化者,测量斑块负荷.结果 76例冠状动脉造影正常左主干患者中IVUS显示完全正常28例,内膜增生12例,有斑块36例,发现内膜斑片2例.对于存在斑块者偏心斑块为30例,向心斑块为6例;脂质斑块25例(占69.4%),纤维斑块4例(占11.1%),钙化斑块2例(占5.6%),混合斑块5例(占13.9%).IVUS显示女性左主干正常者的管腔直径为(5.32±0.68)mm,管腔面积为(23.34±5.27)mm2,男性左主干正常者的管腔直径为(5.90±0.50)mm,管腔面积为(27.75±4.47)mm2.男女管腔直径和管腔面积比较差别均有统计学意义(P值分别为0.042和0.048).内膜增生者血管直径为(5.90±0.47)mm,血管面积为(27.58±4.21)mm2;存在斑块者的管腔直径为(4.39±0.54)mm,管腔面积为(17.45±5.23)mm2,血管直径为(5.99±0.67)mm,血管面积为(26.61±6.27)mm2,直径狭窄百分比为(26.17±7.87)%,斑块负荷为(34.79±9.37)%.结论 IVUS能发现冠状动脉造影所无法显示的左主干病变,并且能精确地确定左主干病变的性质和严重程度.     

血管内超声在自发性冠状动脉夹层诊断和治疗中的初步应用

目的初步探讨血管内超声（IVUS）在自发性冠状动脉夹层（spontaneous coronary artery dissection，SCAD）诊断和介入治疗中的应用价值。方法采用IVUS观察6例SCAD的显像特征，并指导3例SCAD的冠状动脉内支架植入治疗。结果6例患者IVUS均清晰显示内膜片结构，根据真假腔外侧壁的超声结构差异和假腔内血栓，6例患者均成功鉴别出真假腔。3例接受冠状动脉内支架植入治疗的患者，根据IVUS显像准确选择支架尺寸，指导支架在真腔内释放，并确定支架扩张充分和夹层完全闭合。结论应用IVUS有助于对SCAD进行精确的评估，准确地指导SCAD的冠状动脉内支架植入并评价其疗效。     

血管内超声对不稳定性心绞痛患者的临床研究

目的：探讨血管内超声（IVU S）对不稳定心绞痛（UA）患者介入治疗的价值。方法：UA患者20例,其中男12例,女8例,平均年龄（57.8±3.2）岁,冠状动脉造影（CAG）未见明显狭窄,通过IVU S检查,对斑块的性质、形态、部位、血管的狭窄程度、血管重构情况进行分析,再选择介入治疗与否。结果：IVU S检查共发现位于前降支（LAD）回旋支（LCX）及右冠状动脉（RCA）的斑块22处,其中纤维斑块6例,软斑块12例,4例钙化斑块。8例施行了支架植入的患者的临床症状明显好转。结论：CAG未见明显狭窄的UA患者有必要进行IVU S检查,因可明确冠状动脉斑块性质,为是否需要介入治疗提供重要依据。     

16层CT冠状动脉成像与选择性冠状动脉造影的对比研究

目的:探讨16层CT对冠状动脉粥样硬化病变的显示情况及临床价值。方法:39例患者进行16层CT冠状动脉造影检查(疑似冠心病者31例,PTCA术后8例)及选择性冠状动脉造影。分析16层CT对冠状动脉各节段的显示情况。以管腔直径减小>50%为标准,判定冠状动脉狭窄。分析16层CT诊断冠状动脉狭窄的敏感性、特异性及符合率,及对病变性质的显示情况。结果:16层CT对冠状动脉的总体显示率为94.8%(333/351)。评价冠状动脉病变的总体敏感性为82.2%,特异性为94.7%,符合率为86.0%。16层CT显示钙化及非钙化斑块混合存在致血管狭窄21处,高估3处;中间密度斑块致狭窄8处,高估3处;软斑块3处,无显著狭窄。16层CT能清晰显示支架位置、形态及远端血流,1例再狭窄,1例闭塞,余通畅,其结果与选择性冠状动脉造影一致。另外,16层CT显示冠状动脉起源变异2例,前降支冠状动脉瘤1例,室壁瘤1例,房间隔缺损1例。结论:16层CT冠状动脉成像是一种颇具潜力的无创性检查方法,能够较为准确、全面的评价冠状动脉病变。     

血管内超声显像在造影无显著狭窄病变的急性冠脉综合征中的应用

目的探讨血管内超声显像(IVUS)在冠状动脉造影无显著狭窄病变的急性冠状动脉综合征的病变检测和指导治疗中的应用价值.方法选取临床诊断急性冠状动脉综合征患者21例,4例为急性Q波性心肌梗死,3例为非Q波性心肌梗死,14例为不稳定型心绞痛,所有病例经冠状动脉造影主要冠脉未见直径狭窄>60%的病变.对靶血管(LAD 17例,RCA 3例,LCX 1例)行IVUS检查.结果 21例21处病变中14例(66.7%)为软斑块,2例(9.5%)为纤维斑块,4例(19.0%)为钙化斑块,1例(4.8%)为混合型斑块;共19例(90.5%)为偏心性斑块;13例(61.9%)正性重构,8例(38.1%)负性重构;重构指数为1.02±0.10(￣x±s).21例患者中有5例发现有斑块破裂,占23.8%;2例发现血栓,占9.5%.面积狭窄率(斑块负荷)范围从43.0%至79.1%,平均为70.0%±8.8%.病变处最小管腔直径(MLD)为(2.29±0.50) mm.IVUS测得的直径狭窄率、面积狭窄率、最小管腔面积和参照血管直径均大于定量冠状动脉造影所测得的数值(P均<0.05).根据IVUS检查结果,15例进行了血运重建术(1例冠脉搭桥术,14例支架植入术).结论在冠状动脉造影无显著狭窄病变的急性冠状动脉综合征病人中,血管内超声检查有助于明确病变的程度、性质并指导治疗方案的选择,病变的偏心性和正性重构可能是造成冠脉造影低估病变程度的主要原因.     

血管内超声对冠状动脉临界病变处理的应用价值

目的 探讨血管内超声(IVUS)在判断冠状动脉造影临界病变介入治疗指征中的价值。方法 对68例稳定型心绞痛(SA)患者(26例)和不稳定型心绞痛(UA)患者42例做冠状动脉造影(CAG)，显示单支临界病变的患者行IVUS检查，以面积狭窄60％或偏心脂质斑块作为介入治疗指征。结果 68处病变进行介入治疗50处(73．53％)，时于血管直径的判断，IVUS优于CAG；时于有价值病变的检出，UA组优于SA组。结论 对于CAG显示的临界病变，尤其是表现为UA者。有必要进一步行IVUS检查。     

Intravascular ultrasound detected calcification of coronary lesions as a predictor of dissections after balloon angioplasty

Dissection after balloon angioplasty of coronary arteries may give rise to an unfavourable early outcome. Compared with coronary angiography, intravascular ultrasound (IVUS) allows more detailed characterisation of dissections. We investigated the incidence and the type of dissections after balloon angioplasty in calcified coronary lesions. IVUS was performed in 43 patients with 48 lesions before and after percutaneous balloon angioplasty. Significant calcification was defined as an are of more than 90° with typical acoustic shadowing. Dissections were classified as type A when the media was not involved by the dissection and as type B when media involvement had occured. In the group with significant calcification dissection was observed in 79 % of the cases vs. 38 % in the control group (p<0.03). Type B dissection was present in 71 % of the dissections in the calcified lesions vs. 15 % in the control group (p<0.02). The balloon diameter and the ratio of balloon area to vessel area was not different in both groups but the required pressure for the first complete balloon inflation was significantly greater in the group with calcified lesions (9.46±3.6 atm vs. 6.65±2.6 atm; p<0.001). Thus balloon angioplasty in calcified coronary lesions is more likely to lead to dissection which frequently involve the media.     

经皮冠状动脉成形术中的冠状动脉破裂原因分析

目的：探讨冠状动脉成形术中冠状动脉破裂的可能原因。方法：对所有介入治疗前的靶病变行定性和定量造影分析,并选择在发生冠状动脉破裂前最近一次的血管内超声（IVUS）图像进行分析。结果：在5个心脏介入中心总共1 506例经皮冠状动脉成形术（PCI）患者中,发生冠状动脉破裂15例（1.0%）,其中6例与操作导丝相关,1例与单纯球囊扩张相关,8例与支架植入相关。6例与导丝相关的破裂均由亲水涂层或中等硬度导丝所致,靶病变包括3例闭塞、4例偏心和3例分叉病变。与球囊或支架相关冠状动脉破裂包括6例偏心、6例中等至严重钙化病变。有血管内超声分析的5例,其病变偏心率均小于0.4,钙化弓在42~109度。除了单纯球囊破裂病例,在所有支架植入导致的破裂,球囊/管腔比值均超过1.3。所有与导丝相关冠状动脉破裂属于EllisⅡ级,与球囊或支架相关的2例属Ⅱ级,7例属Ⅲ级。结论：导丝相关的冠状动脉破裂常发生在采用亲水涂层或中等硬度导丝对偏心、分叉或闭塞病变进行操作;球囊或支架相关冠状动脉破裂经常与球囊尺寸过大或压力过大有关,常发生在偏心和伴钙化的病变处。     

血管内超声对冠脉病变的诊断价值

目的探讨血管内超声对冠脉病变的诊断价值。方法选择2011年1月-2011年9月在我院诊断为冠心病或可疑冠心病的44例患者(57处病变)进行血管内超声与冠状动脉造影术检查,对比分析两种方法对冠脉病变的检查结果。结果本组3例患者CAG检查未发现冠脉狭窄,而IVUS检查均有不同程度狭窄。CAG检测直径狭窄率和面积狭窄率分别为(32.52±9.85)%和(45.7±17.28)%,明显低于IVUS测得的(46.64±10.19)%和(61.53±14.80)%,差异有统计学意义(P<0.05)。IVUS对钙化斑块、偏心性斑块的检出率明显高于CAG,差异有统计学意义(P<0.05)。CAG无法判定斑块硬斑块、软斑块。结论血管内超声可以明确狭窄冠脉的性状,较CAG更准确评估血管病变程度,对冠心病患者的诊断及治疗具有重要价值。     

Atherosclerosis found on carotid ultrasonography is associated with atherosclerosis on coronary intravascular ultrasonography.

OBJECTIVE: Little has been reported on the relationship between left main coronary artery atherosclerosis and carotid ultrasonographic results. We evaluated the association between carotid and coronary atherosclerosis assessed by coronary intravascular ultrasonography (IVUS) in 45 patients. METHODS: We counted the number of plaques with intima-media thickness (IMT) greater than or equal to 1.1 mm and calculated a plaque score by summing all plaque thicknesses. With the use of IVUS, the percent plaque area was calculated at the proximal, middle, and distal sites of the left main coronary artery. The maximum percent plaque area and mean percent plaque area of the 3 sites were also calculated. Relationships among the degree of left main coronary artery atherosclerosis and carotid atherosclerosis and vascular risk factors were evaluated. RESULTS: The mean percent plaque area and maximum percent plaque area were increased in men and in patients with hypertension compared with women and those without hypertension (P < .1). Both the average of the maximum common carotid IMT and plaque number were correlated with both the mean percent plaque area and maximum percent plaque area (P < .05). Men, the presence of hypertension, and the average of the maximum common carotid IMT were correlated with both the mean percent plaque area and maximum percent plaque area by multiple linear regression analysis (P < .05). CONCLUSIONS: The average of the maximum common carotid IMT was significantly correlated with left main coronary artery atherosclerosis evaluated by IVUS.