血管内超声在冠状动脉临界病变诊断及治疗中的应用

血管内超声是近年来发展起来的一项新的影像学技术,在冠心病的诊断与治疗中有着重要的应用价值,尤其对临界病变的评估有着很好的指导作用。该项技术的问世,不仅使冠状动脉临界病变的检出越来越多,而且在识别易损斑块方面有着突出的贡献,从而指导冠心病临界病变患者选择合适的治疗方案,进行及早干预,减少心血管事件的发生。因此,在冠状动脉造影中应用血管内超声检查已然成为目前诊断和治疗冠状动脉临界病变的热点问题。     

血管内超声在临界病变中诊断的应用

血管内超声(IVUS)是近年来应用于冠状动脉病变检测的特殊技术之一,能够对冠状动脉血管病变进行精确的定性和定量评价.与冠状动脉造影技术不同的是,IVUS能提供冠状动脉血管横截面的图像,不仅能够能让我们了解病变处管腔的具体形态,还可以进一步显示血管壁结构,做到对冠脉病变更准确的分析,尤其是临界病变中的应用,能够更好对临界病变做出诊断并指导我们对于临界病变治疗方案的选择.     

冠状动脉临界病变的评价及治疗

冠状动脉临界病变指的是冠状动脉造影显示冠状动脉的狭窄程度为30%~69%,在临床上临界病变的发生率远高于显著病变,大约为其20倍;另外,部分临界病变是导致急性冠状动脉综合征的罪犯血管,故判断和评估其功能对决策治疗有重要的临床意义。虽然冠状动脉造影仍为诊断冠心病的金标准,然而冠状动脉造影只是对狭窄血管进行解剖性评价,不能对病变处进行病理生理及功能性评价。目前对冠状动脉临界病变的主要检查方法有:负荷超声心动图、多层螺旋CT、CT血管造影确定血流储备分数、放射性核素心肌灌注显像和心脏核磁共振等,这些都为无创性检测手段,冠状动脉血流储备、血流储备分数、光学相干断层扫描技术、血管内超声等有创性检测手段也受到广泛关注。现就冠状动脉临界病变的无创及有创性评价以及治疗做一综述。     

血管内超声在左主干病变介入治疗中的应用

冠状动脉造影只能提供血管腔的二维图像,对于左主干病变的诊断有局限性。血管内超声作为目前应用最广泛、最成熟的血管内成像技术,可提供血管壁、内径、斑块负荷等信息,有助于术者判断临界病变,并选择最佳的治疗策略及手术器械,从而优化左主干病变的介入治疗,预防和减少并发症。     

冠状动脉非左主干临界病变患者定量冠状动脉造影与血管内超声测值的比较

目的 分析血管内超声(IVUS)与定量冠状动脉造影(QCA)对冠状动脉非左主干临界病变相关参数分析,探讨IVUS和QCA在非左主干临界病变中的诊断价值.?方法 入选2017年9月至2019年12月在湖州市中心医院心内科行冠状动脉造影提示为非左主干临界病变患者102例,对所有病变部位分别行QCA及IVUS测量,测量相关参...     

血管内超声在冠心病诊断与治疗中的应用进展

血管内超声(IVUS)是近年来发展起来的一项新影像学技术,在冠心病的诊断与治疗中有重要的临床应用价值.其用于评价冠状动脉病变较冠脉造影(CAG)准确,对冠心病的诊断和治疗决策有着很好的指导作用.本文就目前研究,综述IVUS在冠心病诊断与治疗中的应用进展.     

血管内超声在急性冠脉综合征中的运用价值

目的分析急性冠脉综合征患者冠状动脉造影(CAG)及血管内超声(IVUS)检查数据,探讨血管内超声在定量分析冠状动脉临界病变管腔狭窄率,斑块性质,评价经皮冠状动脉介入(PCI)治疗效果中的作用。研究血管内超声(IVUS)在急性冠脉综合征(ACS)临界病变中的应用价值。方法 2010年1月—2014年3月大同市三医院心内科32例根据临床表现诊断为ACS患者,行冠状动脉造影评估患者左主干(LM)、左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)的管腔狭窄情况;冠状动脉造影发现狭窄≥70%病变直接行PCI,临界病变血管段进行IVUS检测,观察血管壁的形态结构,分析动脉粥样硬化斑块的类型、性质及其狭窄程度,对符合PCI干预指征的病变行PCI术。PCI术后行IVUS检查即刻评价支架置入是否理想、是否合并手术并发症。结果 32例患者中CAG发现冠脉血管12支17处病变管腔直径狭窄率≥70%,予直接行支架植入术,共植入17枚支架;CAG测得38处管腔直径狭窄率为50%~70%(临界病变),经IVUS测得有33处病变管腔狭窄率≥70%,涉及28位患者,共置入33枚支架,单支架23例,双支架5例;3CAG与IVUS检测的38处临界病变处直径狭窄率及管腔面积狭窄率(斑块负荷)比较,IVUS测值显著高于CAG测值有统计学意义(P0.01)。术后行IVUS检查示均显示支架完全贴壁、扩张充分、展开均匀、完全覆盖病变,未发现冠脉内夹层形成、壁内血肿、支架断裂等PCI术后并发症。结论 CAG不同程度地低估了冠状动脉临界病变狭窄,IVUS与CAG相比发现的临界病变管腔狭窄率诊断更精确。IVUS对斑块定性较CAG更优。更能准确选择临界病变支架置入的适应证。IVUS能明确冠状动脉临界病变的性质和狭窄程度。     

冠状动脉内超声显像与造影对冠脉病变检出的意义

医学影像学诊断 (包括Ｘ线显像和超声显像等 )在临床医学中发展迅速 ,随着侵入性技术的广泛应用 ,介入性诊断方法已成为一个十分活跃的领域。冠状动脉内超声显像与冠状动脉造影作为介入性影像学诊断方法也日臻完善 ,两者在临床中的应用提高了对冠状动脉病变的检出 ,也促进了医生对冠状动脉粥样硬化性心脏病本身及介入性治疗后病理解剖和病理生理的理解。1　冠状动脉内超声显像对冠脉病变的检出冠状动脉内超声显像是腔内超声显像在血管内的应用 ,被称为冠心病“新的金标准”和“活体的组织学”检查。早在 195 5年Ｗｉｌｄ应用机械旋转探头为…     

负荷门控核素心肌显像在冠状动脉临界病变评价中的研究进展

冠状动脉临界病变是指冠状动脉造影直径法测得狭窄程度为50%~70%的病变。虽然冠状动脉造影作为诊断冠心病的金标准已被大家公认,但是冠状动脉造影只是对狭窄血管进行解剖学评价,不能对病变血管及其支配心肌进行病理生理及功能性评价,对于冠状动脉临界病变采取何种治疗方案也没有可靠的依据。冠状动脉临界病变在临床中十分常见,且部分病变是导致急性冠状动脉综合征的罪犯血管,因此评价临界病变情况与制定治疗决策十分重要。负荷门控核素心肌灌注显像可以同时评价心肌血流灌注情况和心功能,为临界病变患者的治疗提供依据。现就门控核素心肌灌注显像负荷在评价冠状动脉临界病变中的临床价值做一综述。     

血管内超声在冠状动脉左主干病变介入治疗中的应用

血管内超声能准确地评价冠状动脉的病变程度及范围,除了定量评价管腔的狭窄程度、斑块负荷以外,还能依据斑块病变的回声特点定性分析斑块的性质。血管内超声还用于指导经皮冠状动脉介入术策略的选择,优化经皮冠状动脉介入术的方法及过程,极大程度地弥补了冠状动脉造影的不足,尤其在冠状动脉左主干病变的诊断和介入治疗中有着独特的价值。     

The absence of evidence is not the evidence of absence: A case report on the challenges in diagnosing ostial left main stenosis

Because left main (LM) coronary artery stenosis is known to have higher mortality and morbidity compared to lesions in other territories, an early diagnosis and management are crucial to prevent worse outcomes. Due to limitations of coronary angiography (CA), the diagnosis of ostial LM stenosis solely based on CA may result in underdiagnosis of such lesions. Therefore, additional testing is often needed either by pressure wire or intravascular ultrasound (IVUS) to make appropriate diagnosis. We, hereby, present a case of left main ostial stenosis in a 56-year-old male that was missed on multiple coronary angiograms, and highlights many of the considerations in the diagnosis of LM disease.     

血管内超声在冠状动脉介入治疗中的应用进展

血管内超声显像是近10年来开展的一项新技术,不仅能够准确反映血管腔的变化同时也能清晰显示动脉管壁的解剖结构和斑块特征。随着冠状动脉介入治疗的普及,血管内超声显像在冠状动脉粥样硬化性心脏病的诊断与治疗中发挥着越来越重要的作用,现已成为诊断冠状动脉粥样硬化性心脏病新的"金标准"。它不但能更准确地测量冠状动脉狭窄的严重程度、血管腔的大小、病变长度,以帮助选择更合理的治疗策略,而且可以用于指导支架置入、评价支架内膜增生、探讨支架内再狭窄以及支架贴壁不良和支架内血栓的检出等。现回顾近几年的研究,就血管内超声显像在冠状动脉介入治疗中的应用做一综述。     

血管内超声对冠状动脉弥漫性斑块的应用价值

目的:应用血管内超声(IVUS)对冠状动脉(冠脉)弥漫性斑块患者进行检查,比较IVUS与冠脉造影(CAG)对冠脉弥漫性斑块的诊断价值。方法:对经CAG发现冠脉弥漫性狭窄或可疑的39例患者(39支冠脉血管,其中左前降支16例,左回旋支12例,右冠脉11例)同时进行IVUS检查,对照这2种检查结果进行比较。结果:CAG显示的病变血管狭窄程度(面积狭窄率)及斑块累及长度明显低于IVUS所示的结果,而IVUS显示斑块累及范围明显大于CAG结果[(39.48±9.33)mm∶(30.26±8.57)mm],在弥漫性斑块累及冠脉的狭窄率上IVUS高于CAG[(67.2±8.1)%∶(60.3±7.3)%],二者差异具有统计学意义(P<0.05)。CAG无法显示冠脉内形态及斑块性状,而通过IVUS可以清晰显示斑块的形态与性状。结论:对于冠脉内弥漫性斑块,CAG低估了病变程度,IVUS可以直接看到冠脉的横截面,从而明确冠脉狭窄的性状和严重程度,相对于CAG来说,IVUS是评价弥漫性斑块的一种精确方式。     

血管内超声与冠状动脉造影在不稳定性心绞痛患者冠状动脉轻度狭窄中的显像特征

目的探讨血管内超声(IVUS)与冠状动脉造影(CAG)在不稳定性心绞痛患者冠状动脉轻度狭窄中的显像特征。方法对经CAG发现冠状动脉轻度狭窄的30例不稳定性心绞痛患者42处病变进行IVUS检查,观察病变斑块性质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发现,偏心性狭窄26处,向心性狭窄16处,病变最窄处血管直径狭窄率为(29.06±7.20)%;IVUS发现,偏心性斑块34处,向心性斑块8处,易损斑块28处,病变最窄处血管直径狭窄率为(37.37±6.50)%,面积狭窄率为(41.51±7.50)%。IVUS所测病变最窄处血管直径狭窄率明显高于CAG(P<0.05)。结论 CAG低估血管内病变情况,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。     

应用血管内超声显像技术评价冠状动脉病变与颈动脉病变相关性

目的 通过研究血管内超声、冠状动脉造影检查结果与体表颈动脉超声检测的颈动脉病变的相关性,分析颈动脉粥样硬化与冠心病的关系,进一步探讨颈动脉粥样硬化对冠心病发病的预测价值.方法 38例拟诊为冠心病的患者行冠状动脉造影、血管内超声和体表颈动脉超声检查,其中8例患者经冠状动脉造影和血管内超声检查未发现冠状动脉有明显狭窄病变为对照组;30例经冠状动脉造影和血管内超声检查发现冠状动脉有明显狭窄病变为冠心病组,其中不稳定型心绞痛18例,稳定型心绞痛12例.将血管内超声及冠状动脉造影检查结果与颈动脉超声指标进行分析比较.结果 30例冠心痛患者冠状动脉造影平均直径狭窄率71.21%±9.81%,血管内超声示有不同类型的动脉粥样硬化斑块,平均面积狭窄率80.88%±7.77%;8例对照组无动脉粥样硬化斑块.冠状动脉造影平均直径狭窄率与血管内超声平均面积狭窄率之间差异有显著性(P<0.01);冠状动脉造影平均直径狭窄率与血管内超声平均面积狭窄率之间有显著相关性(r=0.663,P<0.01).根据冠状动脉造影平均直径狭窄率计算的Gensini积分分别与颈动脉粥样硬化的等级积分、Crouse积分和斑块数三项指标间均有相关性(P<0.01).颈动脉斑块对冠心痛的阳性预测值为70%(21/30),阴性预测值为75%(6/8).结论 应用血管内超声显像技术能准确诊断冠状动脉斑块的性质并测量冠状动脉狭窄率;与冠状动脉造影相比,血管内超声对评价冠状动脉病变更准确.颈动脉粥样硬化严重程度与冠状动脉血管内超声检查结果有很好的相关性;颈动脉超声检测对冠心病的诊断有一定的预测价值.     

Value of intravascular ultrasound in guiding coronary interventions

There has been great effort to improve clinical outcome in percutaneous treatment for coronary artery disease. Complementary to coronary angiography, intravascular ultrasound (IVUS) provides in vivo tomographic anatomic information, enabling to evaluate from the lumen to the vessel wall. As a result, IVUS has had a pivotal role to understand pathophysiology of coronary artery disease and improve clinical outcome. It provides preprocedural information to evaluate stenosis severity and plaque characteristics and helps with optimal stent deployment, minimizing underexpansion and geographic miss that are the major mechanisms of stent failure. Recently, many large‐scale clinical trials and meta‐analyses with drug‐eluting stents have shown the clinical benefits of IVUS‐guided percutaneous coronary intervention. Some recent studies have also supported the cost‐effectiveness of IVUS‐guided PCI especially in high‐risk patients. This article will discuss the clinical value of IVUS in contemporary practice.     

The impact of coronary artery disease risk factors on intravascular ultrasound-derived morphologic indices of human coronaries

OBJECTIVE: The relationship of intravascular ultrasound (IVUS)-derived measurements of atherosclerotic plaque to various coronary artery disease (CAD) risk factors is not well known. The purpose of this study was to examine the relationship of percent coronary luminal stenosis by IVUS to other IVUS measures of CAD, as well as the relationship of common IVUS measures of CAD to traditional CAD risk factors. We hypothesized that one or more IVUS measures of CAD might relate more strongly to CAD risk factors than does percent luminal coronary stenosis. METHODS: The records of 897 consecutive patients (57% men, mean age 62 years) who underwent IVUS investigation of their coronary arteries from 1996 through 2001 were retrospectively reviewed. IVUS was performed using a 20-MHz probe (Jomed, Rancho Cordoba, CA) and a manual pull-back technique to image the coronary arteries. Coronary artery remodeling ratio-i.e., the ratio of coronary lesion external elastic membrane cross-sectional area (EEM CSA) to proximal reference artery EEM CSA; plaque burden-i.e., plaque plus media CSA divided by EEM CSA; calcium arc; and percent stenosis of luminal cross-sectional area were measured by a single reader. RESULTS: Percent area stenosis, the most commonly used IVUS parameter, did not correlate with the other three IVUS-derived parameters, nor was it related to any of the CAD risk factors considered. In contrast, remodeling ratio was directly correlated with plaque burden (r=0.22, P<0.001), but inversely related to calcium arc (r=-0.13, P=0.01). IVUS plaque burden was significantly correlated with male gender (P<0.0001) and diabetes mellitus (DM) (P=0.003). In multivariate analyses including age, gender, and CAD risk factors, plaque burden was significantly associated with age, male gender, and DM, but not with chronic renal failure, hypertension, or hypercholesterolemia. The multivariate model also revealed that the calcium arc was significantly associated with male gender and age. These IVUS findings provide anatomic documentation that the traditional CAD risk factors relate more strongly to plaque burden than to percent coronary arterial luminal narrowing.     

Percutaneous revascularization of left main

Refinement of interventional techniques, adjunctive pharmacological therapy, and the introduction of drug‐eluting stents have fostered new interest for the percutaneous treatment of unprotected left main coronary artery (ULMCA) stenosis. Several observational registries, some randomized trials and several meta‐analyses have consistently shown no difference in mortality and myocardial infarction between percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery in patients with ULMCA stenosis, but a higher rate of target vessel revascularization in patients treated with PCI. As a consequence, PCI of ULMCA stenosis has been upgraded to class IIa or IIb indication in the current European or American practice guidelines. However, several critical issues should be properly addressed when pursuing a percutaneous strategy for the treatment of ULMCA stenosis, such as the use of IVUS for procedural guidance, assessment of disease location, optimal technique for distal ULMCA stenosis, risk of stent thrombosis, optimal duration of dual antiplatelet therapy, and the most appropriate strategy for post‐procedure follow up. Multidisciplinary team approach remains essential to provide a balanced information to the patient and to offer the beast treatment option. © 2011 Wiley Periodicals, Inc.     

老年冠状动脉疾病双源CT检查的临床意义

目的探讨双源CT（DSCT）在老年冠状动脉疾病检查中的临床意义。方法对58例有症状拟诊冠心病心绞痛或有冠心病高危因素的老年患者应用DSCT检查。对12例中重度患者行选择性冠状动脉造影（SCA）检查。以SCA检查结果为金标准,探讨2种检查方法在诊断老年冠状动脉疾病方面有无统计学差异。结果 58例老年患者DSCT检查显示冠状动脉583段,狭窄病变126段,其中轻度狭窄病变45段,中度狭窄病变39段,重度狭窄病变39段,闭塞3段。DSCT和SCA在检查冠状动脉中重度狭窄及闭塞上无统计学差异（P〉0.05）。结论 DSCT是一种无创、简便、安全可靠的影像学的检查方法,有较高的敏感性和特异性,在评价老年患者中重度冠脉狭窄上与SCA具有较高的符合性与一致性,值得临床推广。