应用血管内超声探讨冠状动脉不同长度支架置入后对斑块重新分布的影响

目的 探讨冠状动脉支架置入后斑块的重新分布对支架边缘的影响及此影响是否与所置入支架长度有关.方法 47例行经皮冠状动脉介入治疗(PCI)的稳定性和不稳定性心绞痛患者,冠状动脉内共置人支架70枚,根据支架的长度分为两组,支架长度≤18 mm和>18 mm组.于支架置入前后的支架远端边缘(支架远端5 mm)、支架和支架近端边缘(支架近端5mm)进行血管内超声(IVUS)图像分析,测量冠状动脉横截面上的管腔面积(LA)、血管面积(VA).三段分析部位的LA和VA的平均值乘以三段的长度(即5 mm、支架长度和5 mm)即为三段的管腔体积(LV)和血管体积(VV).VV-LV=管壁体积(WV),支架两端移动斑块体积=支架置入后WV-支架置入前WV.结果 在支架长度≤18 mm组支架近远端分别检测到91%和93%斑块移位(P>0.05),在支架长度>18 mm组支架近远端分别检测到80%和91%的斑块移位(P<0.05).支架置入后支架长度≤18 mm组支架近远端和支架长度>18 mm组支架近端边缘,LV缩小、VV无变化、WV明显增加,即由于斑块的移位造成支架置入后即刻以上部位有明显的管腔缩小,但是支架长度>18 mm组支架远端边缘情况不同,LV和VV反而增加,WV有所增加,即在支架长度>18 mm组支架远端边缘斑块的移位并没有造成支架置入即刻管腔的缩小.结论 长、短支架置入后对支架近远端边缘斑块的移位和管腔的影响不同,短支架近远端和长支架近端边缘在支架置入后有斑块的移入和管腔的缩小,而长支架远端边缘虽有斑块的移入但无管腔的缩小.     

血管内超声技术对冠心病介入性诊疗中临床价值的研究

目的：探讨血管内超声（IVUS）在冠状动脉粥样硬化诊断、指导及评价经皮冠状动脉介入（PCI）中的作用。方法：对106例行冠状动脉造影（CAG）患者的152处冠状动脉血管段于支架置入术前、67处血管段于术后及21处于高压球囊扩张后进行IVUS检测。结果：IVUS在显示血管壁的形态结构、斑块的性质方面敏感性高于CAG检查，诊断冠心病更准确，血管造影低估冠脉病变的严重程度；本组152处血管，经CAG和IVUS检查符合介入治疗干预指征的血管67处，IVUS指导置入支架的大小、长度以及置入的位置，支架置入术后，血管总截面积、管腔面积增加，斑块面积及面积狭窄率降低；高压球囊扩张前后斑块面积差异无显著性，血管总截面积、管腔面积、面积狭窄率有显著性差异。结论：IVUS诊断冠心病的敏感性和特异性均为100％，IVUS是诊断冠心病的金标准；IVUS能准确选择支架置入的适应症、帮助选择支架大小，支架置入后可精确评价支架扩张是否充分。血管内超声是目前指导支架置入和评价支架置入效果的最佳手段。     

增龄性冠状动脉斑块钙化特征分析在男性冠心病防治中的应用价值

目的利用血管内超声(IUVS)评价增龄性冠状动脉钙化斑块的形态学特征并分析其在冠心病防治中的应用价值。方法选取行冠状动脉造影(CAG)及IVUS检查的青年组、中年组、老年组三组不同年龄段男性冠心病患者103例,在介入治疗前对钙化病变血管进行IVUS检查,获取血管外弹力膜面积、斑块狭窄面积、管腔钙化斑块狭窄率,测量病变钙化弧度、钙化长度比与钙化指数,并进行年龄因素相关分析。结果①随着年龄的增长,各组靶血管病变的血管外弹力膜面积和斑块面积均有逐步减少与升高的变化趋势,差异有统计学意义(P<0.05)。②钙化弧度、重度钙化率、钙化长度比随着年龄增长而呈现显著增加趋势,在老年组变化程度最明显(P<0.05)。③相关性分析发现钙化相关指标与增龄后的管腔斑块狭窄等指标有显著正相关(P<0.05)。结论随着年龄的增长,斑块钙化的程度逐渐加重,且呈现向心性演变趋势。在IVUS辅助下进行钙化特征相关指标的测定对指导男性冠心病患者复杂钙化病变的介入治疗有重要意义。     

旋磨术联合切割球囊成形术治疗冠状动脉重度钙化病变

目的血管内超声评价旋磨术联合切割球囊成形术治疗冠状动脉重度钙化病变的安全性及有效性。方法收集冠状动脉造影及血管内超声检查确认至少1处病变为高度钙化,并行旋磨术处理的冠心病患者80例,根据是否使用切割球囊分为单纯旋磨组34例和旋磨联合切割组46例。患者在支架置入前及置入后均行血管内超声检查,评价支架置入效果。结果单纯旋磨组与旋磨联合切割组最大钙化弧度分别为(215.88±21.81)°vs(226.55±21.59)°,钙化长度比为(0.72±0.06)vs(0.78±0.05),支架置入前最小管腔面积为(2.52±0.07)mm2 vs(2.46±0.09)mm2,2组比较差异无统计学意义(P>0.05)。支架置入后,旋磨联合切割组最小支架面积(6.12±0.37)mm2和即刻管腔获得面积(3.66±0.34)mm2,单纯旋磨组分别为(5.42±0.24)mm2和(2.90±0.24)mm2,2组比较差异有统计学意义(P=0.016)。2组术中并发症的发生比例比较,差异无统计学意义(P>0.05)。结论在冠状动脉重度钙化病变中,使用旋磨术联合切割球囊成形术可以获得更好的支架置入后效果。     

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。     

冠状动脉内超声的临床应用价值

目的 :探讨冠状动脉内超声 ( ICUS)的临床应用价值。方法 :采用美国 Endosonics公司生产的固态相控阵血管内超声显像仪对 64例冠心病患者进行 ICUS成像 ,根据 ICUS计算偏心指数 ,确定斑块的几何形态和斑块的性质。测量近端参考段和病变段血管的最小腔面积和最小腔直径 ,计算面积狭窄百分比和直径狭窄百分比。结果 :64例患者的 12 3段病变血管中 ,44段为纤维性斑块 ,5 6段为混合性斑块 ,18段为钙化性斑块 ,15段为软斑块。 31例患者的 43段病变血管在支架置入术前、术后进行了 ICUS检查 ,支架扩张后的直径为 2 .6～ 3.5 ( 3.14± 0 .2 6) mm,腔面积 5 .78～ 11.4( 6.79± 0 .71) mm2 ,面积狭窄百分比和直径狭窄百分比在支架置入前、后有极显著性差异 ( P <0 .0 0 1)。对 84段血管冠状动脉狭窄程度的评价 ,ICUS与冠状动脉造影无显著性相关。结论 :ICUS可以发现冠状动脉早期病变 ;对冠状动脉造影显示中等程度狭窄可进行精确评价 ,决定是否需要介入治疗 ;根据不同的声学特征 ,帮助选择适当的治疗措施 ;评价介入治疗的即刻效果 ,研究介入治疗及介入治疗后再狭窄的机制。     

氧化低密度脂蛋白和血管内超声预测介入术后支架内再狭窄

目的探讨氧化低密度脂蛋白(oxidized-low density lipoprotein,ox-LDL)和血管内超声在预测经皮冠状动脉介入术(percutaneous coronary intervention,PCI)后支架内再狭窄的价值。方法2006～2008年,佛山市第一人民医院实施PCI180例,随访患者经冠状动脉造影(coronary angiography,CAG)证实支架内再狭窄28例。PCI术前及随访时以酶联免疫法测定ox-LDL,用血管内超声检测病变血管的外弹力膜面积、斑块面积、最小管腔面积和内膜面积。结果无支架内再狭窄患者PCI前后ox-LDL差异无统计学意义;支架内再狭窄患者ox-LDL在PCI术后升高[(70±18)μg/L比(78±19)μg/L,P<0.05)];支架内再狭窄组与支架内无狭窄组比较,两组外弹力膜面积差异无统计学意义、两组斑块面积分别为(6.8±2.4)mm2和(5.1±1.6)mm2,P<0.05;最小管腔面积分别为(4.7±1.9)mm2和(6.2±2.1)mm2,P<0.05;最小管腔的支架面积分别为(1.95±0.33)mm2和(1.49±0.21)mm2,...     

药物涂层球囊在糖尿病患者冠状动脉小血管病变中的疗效分析

目的:观察药物涂层球囊(DCB)在糖尿病(DM)患者冠状动脉小血管病变应用中的有效性及近期疗效。方法:入选DM冠状动脉小血管病变患者39例,均单独应用DCB治疗,记录治疗前后最小管腔直径(MLD)、手术即刻成功率及主要不良心血管事件(MACE)发生率。6个月后复查冠状动脉造影,观察靶血管MLD,计算晚期管腔丢失(LLL)。结果:39例患者共46处病变接受DCB治疗,DCB扩张后,1处病变管壁急性弹性回缩,2处病变出现C型夹层,给予补救性置入药物洗脱支架(DES),手术即刻成功率93.48%,术后即刻MLD较术前显著增加(1.64±0.38)mm对(0.92±0.43)mm,P0.01,所有患者随访期间无死亡、心肌梗死事件发生。术后6个月28例患者复查冠状动脉造影,2例发生较明显的再狭窄,其中1例置入DES,1例再次给予DCB扩张治疗,复查造影患者的MLD为(1.46±0.32)mm,LLL为(0.18±0.31)mm。按靶血管部位分别计算,6个月后与术后即刻MLD比较,差异无统计学意义;按总体靶血管计算,差异有统计学意义(P0.05)。结论:DCB可显著增加DM患者冠状动脉小血管病变管腔直径,LLL较少,且耐受性好,无异物置入,即刻及短期疗效肯定。     

碱性磷酸酶联合血管内超声对ACS患者经皮冠状动脉介入治疗后非靶血管病变进展的预测价值

目的 探讨碱性磷酸酶(alkaline phosphatase,ALP)联合血管内超声(intravenous ultrasound,IVUS)对急性冠状动脉综合征(acute coronary syndrome,ACS)患者经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗后非靶血管病变进展的预测价值。方法 选择2017年6月至2019年7月在河南中医药大学人民医院心内科收治住院并行PCI治疗的ACS患者241例为研究对象，根据随访1年是否出现非靶血管再狭窄分为再狭窄组(28例)和对照组(213例)，对比分析两组患者间观察指标的差异。结果 ALP、病变长度、IVUS显示钙化、IVUS钙化分类、IVUS钙化长度、钙化弧度、钙化特征评分、最小管腔面积(minimum lumen area,MLA)≤4 mm²、斑块负荷(plaque load,PB)>70%均为PCI治疗后非靶血管斑块进展的危险因素(P<0.05)。钙化特征评分预测PCI治疗后非靶血管斑块进展灵敏度为69.44%，特异度为75.81%，曲...     

血管内超声技术在冠心病经皮冠状动脉介入治疗中的临床应用价值

目的探讨血管内超声技术在冠心病(CHD)经皮冠状动脉介入(PCI)治疗中的临床应用价值。方法选取2015年1月—2016年7月我院收治的CHD病人208例,依据检查方法不同分为两组,接受血管内超声技术(IVUS)引导下PCI治疗的病人93例为IVUS组,接受选择性冠状动脉造影(CAG)引导下PCI治疗的病人115例为CAG组,比较两组血管造影情况、支架置入情况及临床结局。结果 IVUS组支架扩张时最大球囊压力、管腔直径最大获得值及PCI后最小管腔直径均大于CAG组(P0.05),PCI后残余狭窄率明显小于CAG组(P0.05)。置入术后分别采用IVUS与CAG检查评价即刻效果,IVUS显示28处支架开放不理想,需再次行高压球囊扩张,CAG显示2处置入不理想,两组比较差异有统计学意义(P0.05);IVUS组心绞痛住院和亚急性血管闭塞发生率均显著低于CAG组(P0.05)。结论 IVUS技术可指导PCI手术获得较大的管腔直径,从而指导球囊选择和介入治疗过程,减轻术后残余狭窄,降低远期心脏事件发生率。     

靶病变浅表性钙化对经皮冠状动脉介入治疗的影响

目的探讨冠状动脉靶病变浅表性钙化对介入操作及疗效的影响。方法连续收集61例冠心病患者（61处靶病变）,根据血管内超声（IVUS）检测冠脉靶病变钙化情况分为浅表性钙化组和非浅表性钙化组,对比两组之间介入操作特点、经皮冠脉介入治疗（PCI）术后临床及影像学特征。结果浅表性钙化29例,非浅表性钙化32例。浅表性钙化组面积狭窄率大于非浅表性钙化组[（75．70±7．11）％VS（68．78±5．56）％,P=0．019];前者术后支架对称性及支架膨胀指数明显小于后者[（0．85±0．06）US（O．90±0．02）,P=0．016;（0．68±0．14）w（0．82±0．10）,P=0．021]。浅表性钙化组术后最小支架直径[（2．51±0．43）w（2．76±0．29）mm]、最小支架面积[（5．86±1．82）VS（6．73±1．40）miTl气相对管腔获得[（1．26±0．68）坩（1．37±0．72）]趋于小于非浅表性钙化组,但差异未发现统计学意义。两组术中术后并发症差异无统计学意义。所有患者无院内主要不良心脏事件发生。结论冠状动脉靶病变浅表性钙化可能较非浅表性钙化对支架的充分扩张及对称性影响更大。     

Cutting-balloon angioplasty before drug-eluting stent implantation for the treatment of severely calcified coronary lesions

Background Severely calcified coronary lesions respond poorly to balloon angioplasty, resulting in incomplete and asymmetrical stent expansion. Therefore, adequate plaque modification prior to drug-eluting stent （DES） implantation is the key for calcified lesion treat- ment. This study was to evaluate the safety and efficacy of cutting balloon angioplasty for severely calcified coronary lesions. Methods Ninety-two consecutive patients with severely calcified lesions （defined as calcium arc 〉 180% calcium length ratio 〉 0.5） treated with bal- loon dilatation before DES implantation were randomly divided into two groups based on the balloon type： 45 patients in the conventional balloon angioplasty （BA） group and 47 patients in the cutting balloon angioplasty （CB） group. Seven cases in BA group did not satisfactorily achieve dilatation and were transferred into the CB group. Intravascular ultrasound （IVUS） was performed before balloon dilatation and after stent implantation to obtain qualitative and quantitative lesion characteristics and evaluate the stent, including minimum lumen cross-sectional area （CSA）, calcified arc and length, minimum stent CSA, stent apposition, stent symmetry, stent expansion, vessel dissection, and branch vessel jail. In-hospital, 1-month, and 6-month major adverse cardiac events （MACE） were reported. Results There were no statistical differences in clinical characteristics between the two groups, including calcium arc （222.2° ± 22.2° vs. 235.0° ± 22.1 °, p=0.570）, calcium length ratio （0.67 ± 0.06 vs. 0.77± 0.05, P = 0.130）, and minimum lumen CSA before PCI （2.59 ±0.08 mm2 vs. 2.52 ± 0.08 mm2, P = 0.550）. After stent implantation, the final minimum stent CSA （6.26 ± 0.40 mm2 vs. 5.03 ± 0.33 mm2; P = 0.031） and acute lumen gain （3.74 ±0.38 mm2 w. 2.44 ± 0.29 mm2, P = 0.015） were significantly larger ila the CB group than that of the BA group. There were not statis tically differences in stent expansion, stent symmetry, incomplete stent apposition, vessel dissection and branch vessel jail between two groups. The 30-day and 6-month MACE rates were also not different. Conclusions Cutting balloon angioplasty before DES implantation in severely calcified lesions appears to be more efficacies including significantly larger final stent CSA and larger acute lumen gain, without increasing complications during operations and the MACE rate in 6-month.     

Feasibility of intravascular ultrasound studies: Predictors of imaging success before coronary interventions

Background: Intravascular ultrasound (IVUS) is currently used to study lesions during transcatheter coronary therapy. However, before dilation some lesions cannot be reached or crossed with the imaging catheter. Hypothesis: This study seeks to elucidate which factors determine the feasibility of IVUS examination before coronary interventions. Methods: Accordingly, 100 consecutive patients undergoing IVUS examination before coronary angioplasty were prospectively studied. The clinical and angiographic characteristics of 77 patients with a successful IVUS study (Group A) were compared with those of 23 patients in whom IVUS was attempted but the target lesion could not be interrogated (Group B). The echogenic characteristics of the target lesion [before (n = 77) or after intervention (in 18 patients in Group B)] were also studied. Results: Patients in Group B were significantly older (62 ± 7 vs. 57 ± 10 years, p < 0.05) and more frequently had stable angina [8 (35%) vs. 9 (11%), p < 0.05]. The distribution of lesions within the coronary tree and angiographic lesion characteristics including length, eccentricity, calcification, bend location, and the American College of Cardiology/American Heart Association classification were similar in both groups. However, proximal tortuosities (>45° at end diastole) were more frequently found in Group B [20 (87%) vs. 47 (61%), p < 0.05]. In addition, by quantitative angiography, patients in Group B had smaller arteries (reference diameter 2.8 ± 0.4 vs. 3.1 ± 0.4 mm, p < 0.05) and more severe lesions (minimal lumen diameter 0.46 ± 0.24 vs. 0.65 ± 0.34 mm, p < 0.05). On IVUS, calcified lesions were more frequently visualized in Group B (61 vs. 38%, p < 0.05). On multivariate analysis, catheter size, baseline minimal lumen diameter, angiographic proximal tortuosities, and lesion calcification on imaging were independent predictors of the feasibility of IVUS studies. Conclusions: Unsuccessful IVUS studies before intervention occur more frequently (1) in vessels with proximal tortuosities or severe lumen narrowing, (2) in lesions that are calcified on IVUS, and (3) when large imaging catheters are used.     

Stenting after directional coronary atherectomy compared with directional coronary atherectomy alone and stenting alone: a serial intravascular ultrasound study.

BACKGROUND: Directional coronary atherectomy prior to stent implantation (DCA-stent) is expected to be an effective approach to reduce restenosis. The purpose of this study was to determine whether DCA-stent has advantages over DCA alone or stenting alone using serial intravascular ultrasound (IVUS). METHODS AND RESULTS: Serial (pre-, post- and follow-up) IVUS was performed in 187 native coronary lesions treated with each of the 3 strategies. External elastic membrane cross-sectional area (CSA), lumen CSA and plaque CSA were measured. Baseline characteristics were similar. Postprocedural lumen CSA was largest after DCA-stent (11.2+/-2.7 mm2) and DCA (10.8+/-2.5 mm2) than stenting alone (9.0+/-2.9 mm2) (p<0.0005). Follow-up lumen loss was similar. As a result, follow-up lumen CSA was largest after DCA-stent (DCA-stent: 9.1+/-3.4 mm2, DCA: 7.8+/-4.2 mm2, stent: 6.3+/-2.6 mm2, p<0.0005). There was a trend toward a lower rate of restenosis with DCA-stent (DCA-stent, 12.5%; DCA, 18.3%; stent, 18.8%; p=0.57). CONCLUSIONS: DCA-stent is superior to both DCA alone and stent alone in terms of the ability to gain a larger lumen as assessed by IVUS.     

Intravascular ultrasonic predictors of angiographic restenosis after long coronary stenting

The intravascular ultrasound (IVUS) criteria for stent optimization have not been determined in stenting long lesions. We evaluated the predictors of angiographic restenosis and compared it with stent lumen cross-sectional area (CSA) and stent length between short (stent length <20 mm) and long (> or =20 mm) coronary stenting. IVUS-guided coronary stenting was successfully performed in 285 consecutive patients with 304 native coronary lesions. Six-month follow-up angiogram was performed in 236 patients (82.8%) with 246 lesions (80.9%). Results were evaluated using conventional (clinical, angiographic, and IVUS) methods. The overall angiographic restenosis rate was 22.8% (56 of 246 lesions) (short stent 17.6% vs. long stent 32.2%, p = 0.009). Using multivariate logistic regression analysis, the independent predictors of angiographic restenosis were the IVUS stent lumen CSA (odds ratio 1.51, 95% confidence intervals 1.18 to 1.92, p = 0.001) and stent length (odds ratio 0.95, 95% confidence intervals 0.91 to 1.00, p = 0.039). The angiographic restenosis rate was 54.8% for stent lumen CSA of <5.0 mm2 (short stent 37.5% vs. long stent 73.3%, p = 0.049), 27.4% for CSA between 5.0 and 7.0 mm2 (short stent 24.1% vs. long stent 31.7%, p = 0.409), 10.5% for CSA between 7.0 and 9.0 mm2 (short stent 10.0% vs. long stent 12.5%, p = 0.772), and 11.4% for stent lumen CSA of > or =9.0 mm2 (short stent 10.4% vs. long stent 13.3%, p = 0.767) (p = 0.001). Compared with short coronary stenting, long coronary stenting is effective treatment modality to cover long lesions with comparable long-term clinical outcomes in cases of stent lumen CSA of > or =7.0 mm2. Regardless of the stent length, the most important factor determining angiographic restenosis was the IVUS stent lumen CSA in relatively large coronary artery lesions.     

Mechanisms of acute lumen gain following cutting balloon angioplasty in calcified and noncalcified lesions: an intravascular ultrasound study.

Several studies have shown that mechanisms for lumen enlargement following conventional balloon angioplasty (BA) consist of plaque reduction and vessel expansion. To assess the mechanisms of lumen enlargement after Cutting Balloon (CB) angioplasty, intravascular ultrasound images were analyzed in 180 lesions (89 CB and 91 BA). External elastic membrane (EEM) cross-sectional area (CSA), lumen CSA, and plaque plus media (P+M) CSA were measured before and after angioplasty. In the CB group, lower balloon pressure was utilized (P < 0.0001). DeltaP+M CSA was significantly larger (P = 0.02) and deltalumen CSA showed a trend toward being larger (P = 0.07) compared to BA group. For noncalcified lesions, CB resulted in a larger deltaP+M CSA (P < 0.05) and a smaller deltaEEM CSA (P = 0.10) than BA. For calcified lesions, deltalumen CSA was significantly larger in the CB group (P < 0.05) without significant differences in deltaEEM CSA and deltaP+M CSA. Dissections complicated with calcified lesions were associated with larger deltalumen CSA for the CB group. In conclusion, for noncalcified lesions, CB achieves similar luminal dimensions with larger plaque reduction and less vessel expansion compared to BA. On the other hand, for calcified lesions, the CB achieves larger lumen gain, especially in lesions with evidence of dissections.     

血管内超声指导对于冠状动脉真性分叉病变介入治疗长期预后的影响

目的研究血管内超声（intravascular ultrasound,IVUS）指导对于冠状动脉真性分叉病变植入药物洗脱支架（drug eluting stent,DES）长期预后的影响。方法通过分析2005年10月至2010年3月DK—Crush系列随机对照研究入选735例原位冠状动脉真性分叉病变植入DES患者,应用倾向评分匹配临床和造影特征,165例IVUS指导和165例冠状动脉造影指导患者纳入研究,比较两组患者的长期预后。结果两组临床基线资料和造影特征比较,差异无统计学意义（P〉0．05）。IVUS指导组更常见选择双支架策略（P=0．007）,IVUS指导组主支血管（MV）和分支血管（SB）的最大支架直径和支架总长度以及分支血管支架个数显著超过常规造影指导组;介入治疗后QCA分析显示,IVUS指导组分支血管参考血管直径（RVD）和即刻获得以及主支血管近端和分支血管最小管腔直径（MLD）显著超过造影指导组。12个月随访发现两组心脏死亡、靶病变重建（TLR）和主要心血管事件（MACE）比较,差异无统计学意义（P〉0．05）。然而,IVUS指导组晚期支架内血栓和急性心肌梗死发生率显著低于造影指导组,差异有统计学意义（0．6％ vs.4．8％。P=0．04;1．8％ vs.6．7％,P=0．03）。结论IVUS指导冠状动脉真性分叉病变植入DES可以显著减低晚期支架内血栓和由此引起急性sT段抬高心肌梗死发生率而改善长期预后。     

Optical coherence tomography-derived predictors of stent expansion in calcified lesions

Background

Severe coronary artery calcification is associated with stent underexpansion and subsequent stent failure.

Aims

We aimed to identify optical coherence tomography (OCT)-derived predictors of absolute (minimal stent area [MSA]) and relative stent expansion in calcified lesions.

Methods

This retrospective cohort study included patients who underwent percutaneous coronary intervention (PCI) with OCT assessment before and after stent implantation between May 2008 and April 2022. Pre-PCI OCT was used to assess calcium burden and post-PCI OCT was used to assess absolute and relative stent expansion.

Results

A total of 361 lesions in 336 patients were analyzed. Target lesion calcification (defined as OCT-detected maximum calcium angle ≥ 30°) was present in 242 (67.0%) lesions. Following PCI, median MSA was 5.37 mm² in calcified lesions and 6.24 mm² in noncalcified lesions (p < 0.001). Median stent expansion was 78% in calcified lesions and 83% in noncalcified lesions (p = 0.325). In the subset of calcified lesions, average stent diameter, preprocedural minimal lumen area, and total calcium length were independent predictors of MSA in multivariable analysis (mean difference 2.69 mm²/mm², 0.52 mm²/mm, and −0.28 mm²/5 mm, respectively, all p < 0.001). Total stent length was the only independent predictor of relative stent expansion (mean difference −0.465% per mm, p < 0.001). Calcium angle, thickness, and the presence of nodular calcification were not significantly associated with MSA or stent expansion in multivariable analyses.

Conclusion

Calcium length appeared to be the most important OCT-derived predictor of MSA, whereas stent expansion was mainly determined by total stent length.     

血管内超声指导冠状动脉中重度钙化病变介入治疗的效果

目的:评价血管内超声(IVUS)对冠状动脉中-重度钙化病变介入治疗的指导作用及对预后的影响。方法:2009年1月~2013年1月冠状动脉中-重度钙化病变患者219例接受冠状动脉介入治疗,其中95例患者术中应用血管内超声指导,124例患者在单纯冠状动脉造影(CAG)指导下完成介入治疗。结果:两组患者的临床基线特征、靶血管部位、病变类型、置入支架数目、长度、直径;冠状动脉旋磨和切割球囊应用等方面,差异均无统计学意义。两组患者住院期间及术后30 d临床终点事件,包括主要不良心血管事件(MACE)事件、支架内血栓发生率的差异均无统计学意义。随访12个月时,IVUS组MACE事件发生率显著低于CAG组(8.4%vs.17.7%,P0.05),IVUS组靶血管重建发生率显著低于CAG组(3.2%vs.10.5%,P0.05)。IVUS组与CAG组在支架内血栓发生率方面差异无统计学意义(3.2%vs.3.2%)。结论:IVUS指导中-重度冠状动脉钙化病变术后即刻和短期临床效果并不优于CAG,但应用IVUS指导能够显著降低术后1年靶血管重建发生率。