血管内超声在冠状动脉临界病变诊断与治疗中的应用进展

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临床应用价值。其用于评价冠状动脉临界病变较冠脉造影准确,对临界病变的诊断和治疗决策有着很好的指导作用。现就目前研究,综述血管内超声在冠状动脉临界病变诊断与治疗中的应用进展。     

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。     

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…     

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。     

血管内超声在冠状动脉临界病变诊断与治疗中的应用进展

近年来,由于血管内超声(IVUS)技术的迅速发展,其广泛运用于冠心病的临床诊疗中.在冠心病的发生、发展和转归中,冠状动脉内斑块的性质较其导致的管腔狭窄程度更具有决定性的意义.针对冠状动脉临界病变而言,血管内超声发挥着不可替代的作用.IVUS可以对斑块进行定性分析,判断出斑块的稳定性与不稳定性.对此,本研究结合相关的文献...     

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.     

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。     

冠状动脉病变:影像学与生理学评价

近年来,冠心病仍然是世界范围内威胁人类健康的主要死因,冠状动脉造影长久以来一直被认为是评价冠状动脉病变的影像学"金标准"。然而对于一些复杂病变如分叉病变、易损斑块及临界病变等,应用冠状动脉造影评价冠状动脉病变略显局限。因此,为了满足临床需要,新的影像学及生理学评价技术应运而生,目前用于评价冠状动脉病变的有创性或无创性技术有:血管内超声、光学相干断层成像、血流储备分数等。他们各有千秋,并在心血管领域发挥重要的作用。     

血管内超声在冠状动脉临界病变中的应用研究

目的:研究传统冠状动脉定量分析方法(QCA)与血管内超声(IVUS)在冠状动脉临界病变中的应用。方法:共入选经过冠状动脉造影(至少4体位造影)证实病变狭窄处于临界病变的患者150例。将入选者分为:常规冠状动脉造影组90例(QCA),血管内超声组60例(IVUS)。通过QCA和血管内超声定量分析方法分析2组最小管腔直径、参考血管直径、直径狭窄率及最小管腔面积等参数指标;将相关数据建立直线回归分析方程,分析二者之间是否具有线性关系;采用Cox回归模型分析2组免于心血管事件方面差异,观察2组术后住院期间、30d、3个月、6个月、9个月和12个月主要心血管事件。结果:血管内超声组分别采用QCA和IVUS分析,参考血管直径2者具有正相关性分别为(3.28±0.19)mmvs.(3.17±0.21)mm,R=0.627。最小管腔直径分别为(2.04±0.18)mmvs.(2.0±0.17)mm,R=0.782。比较2组之间的参数:QCA组通过计算得出直径狭窄率,与IVUS管腔面积狭窄率之间无相关性(R20.05,P=0.222),IVUS最小管腔面积(4.7±0.67)mm2。通过COX回归模型显示2组在免于心血管事件方面的差异,可见QCA组发生心血管事件率具有较高的趋势。结论:对于临界病变的患者,采用IVUS的方法能够检测出更严重狭窄的发生率,传统冠状动脉造影判定结果往往低估真正的病变情况。对于临界病变的患者,采用IVUS进行测量分析,具有减低心血管事件风险的趋势。     

血管内超声与定量冠脉造影应用于冠脉临界病变诊治的比较

目的 研究血管内超声（intravascular ultrasound,IVUS）在优化民航飞行员冠脉临界病变诊断和治疗中的应用。 方法 通过定量冠脉造影（quantitative coronary angiography,QCA）和IVUS对120例飞行员患者165处冠脉临界病的最小管腔直径（minimal lumen diameter,MLD）、直径狭窄率（diamter stenosis,DS）与最小管腔面积（minimal lumen area,MLA）、面积狭窄率（area stenosis,AS）等参数进行对比分析;对IVUS提示管腔MLA<4 mm2飞行员患者的冠脉临界病变行支架植入术。 结果 ①同一临界病变处QCA显示的MLD,DS及MLA,AS值均小于IVUS相应的测量值,且差异有统计学意义（P<0.01）,表明IVUS对冠脉病变狭窄定量测量方面准确性更高;②IVUS提高血栓病变（15.0% vs. 2.5%,P<0.05）和心肌桥（42.5% vs. 2.5%,P<0.01）的诊断率;③与QCA相比,IVUS直接显示介入治疗中支架的贴壁情况,指导支架扩张完全。 结论 IVUS较QCA能更准确地检测冠脉临界病变范围,更灵敏地诊断血栓和心肌桥,利于全面优化临界病变的诊疗。     

Carotid intima-media thickness by B-mode ultrasound as surrogate of coronary atherosclerosis: correlation with quantitative coronary angiography and coronary intravascular ultrasound findings.

AIMS: Although well supported by postmortem studies, the reliability of carotid atherosclerosis as surrogate marker of coronary atherosclerosis has been put in doubt by in vivo studies showing a poor correlation between carotid intima-media thickness (IMT) detected by external carotid ultrasound (ECU) and coronary stenosis assessed by quantitative coronary angiography (QCA). In the present study, we have investigated whether a stronger in vivo correlation between the two arteries can be obtained by using homogeneous variables such as carotid and coronary IMT, detected by ECU and intravascular ultrasound (IVUS), respectively. METHODS AND RESULTS: ECU, QCA, and IVUS measurements were made in 48 patients. Carotid IMT was correlated with both angiographic and IVUS findings. A significant but weak correlation was observed between ECU and QCA variables (r approximately 0.35, P < 0.05); the correlation between ECU and IVUS measurements of IMT was higher, with correlation coefficients ranging from 0.49 to 0.55. In patients with a QCA diagnosis of normal/intermediate coronary atherosclerosis, the presence of a carotid-IMT(mean) > 1 mm was associated with an 18-fold increase in risk of having a positive IVUS test (OR = 17.99, 95% CI 1.83-177.14, P= 0.013) and with a seven-fold increased risk of having a significant IVUS coronary stenosis (OR = 7.4, 95% CI 1.27-44.0, P = 0.028). CONCLUSION: Carotid atherosclerosis correlates better with coronary atherosclerosis when both circulations are investigated by the same technique (ultrasound) using the same parameter (IMT). This supports the concept that carotid IMT is a good surrogate marker of coronary atherosclerosis.     

Impact of intravascular ultrasound guidance on directional coronary atherectomy

In contrast to the luminogram of coronary angiography, intravascular ultrasound (IVUS) has proven to accurately assess both coronary lumen and vessel morphology due to its 360 degrees imaging capacity. Directional coronary atherectomy (DCA) improves the coronary lumen by removing plaque mass rather than stretching the vessel and compressing the plaque as with conventional percutaneous transluminal coronary angioplasty. In an attempt to optimize the procedural result of DCA we prospectively investigated the impact of IVUS guidance in a head to head comparison to on-line quantitative coronary angiography (QCA) on the result of DCA. In 16 consecutive patients IVUS demonstrated significant residual plaque mass after DCA irrespective of a satisfactory angiographic result. After a mean of 9 +/- 2 cuts luminal improvement was obtained with an area stenosis by angiography of 39 +/- 17% and by IVUS of 50 +/- 10% (p < 0.05), a diameter stenosis by angiography of 23 +/- 10% and IVUS of 35 +/- 14% (p < 0.05) and finally a minimal lumen diameter (MLD) by angiography of 2.9 +/- 0.5 mm and by IVUS of 2.3 +/- 0.5 mm (p < 0.005). After both on-line QCA and IVUS measurements a second series of 7 +/- 2 cuts were initiated to debulk more atheroma and improve stenosis dimensions. After additional cuts IVUS revealed further luminal improvement with an area stenosis by angiography of 25 +/- 16% and IVUS of 21 +/- 18% (n.s.), a diameter stenosis by angiography of 16 +/- 11% and by IVUS of 13 +/- 19% (n.s.) and finally a MLD by angiography of 3.1 +/- 0.5 mm and by IVUS of 2.8 +/- 0.3 mm (p < 0.05). Intraprocedural use of IVUS is superior to on-line QCA to assess the immediate result of DCA. IVUS-guided DCA results in more effective atheroma debulking than luminographic evaluation. Results of larger follow-up studies are needed to substantiate the intraprocedural advantage of IVUS with DCA.     

Comparison of two- and three-dimensional quantitative coronary angiography to intravascular ultrasound in the assessment of intermediate left main stenosis

Angiographic evaluation of intermediate left main coronary artery stenosis (LMS) is often limited. Three-dimensional (3D) quantitative coronary angiography has recently developed to overcome 2-dimensional (2D) quantitative coronary angiographic (QCA) limitations. In patients with angiographically intermediate LMS, we investigated whether 3D quantitative coronary angiography was superior to 2D quantitative coronary angiography in predicting the presence of a significant LMS, defined as a minimum luminal area <6 mm(2) at intravascular ultrasound (IVUS). 2D and 3D quantitative coronary angiography were compared in their measurements of minimum luminal area, percent area stenosis, minimum luminal diameter, and percent diameter stenosis and in their prediction of an IVUS minimum luminal area <6 mm(2). In total 58 target lesions were interrogated, 25 (43%) of which had an IVUS minimum luminal area <6 mm(2). Correlation between 3D-QCA minimum luminal area and IVUS minimum luminal area was stronger than the correlation between 2D-QCA minimum luminal area (or minimum luminal diameter) and IVUS minimum luminal area (R = 0.67, p = 0.0001, and R = 0.40, p = 0.001, respectively, p = 0.04 for comparison). To predict IVUS minimum luminal area <6 mm(2), the most accurate 2D-QCA measurement was minimum luminal diameter (area under curve 0.81, cutoff 2.2 mm, p = 0.0001), and the most accurate 3D-QCA measurement was minimum luminal area (area under curve 0.86, cutoff 5.6 mm(2), p = 0.0001). 2D-QCA percent diameter stenosis did not significantly predict IVUS minimum luminal area <6 mm(2) (area under curve 0.56, cutoff 38%, p = 0.45). In conclusion, the accuracy of quantitative coronary angiography in predicting LM IVUS minimum luminal area <6 mm(2) is limited. When IVUS is not available or contraindicated, 3D quantitative coronary angiography may assist in the evaluation of intermediate LMS. Among 2D-QCA parameters, minimum luminal diameter is more accurate than percent diameter stenosis in predicting significant LMS.     

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。     

血管内超声对冠脉造影临界病变的诊断价值

目的评价血管内超声（IVUS）在冠状动脉临界病变中的应用价值。方法对冠状动脉造影（CAG）提示单支冠状动脉临界病变的83例患者进行IVUS检查,观察病变斑块性质、特征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检查与IVUS检测显示临界病变最小血管径、直径狭窄率、面积狭窄率分别为[（1．87±0．54）mm、（2．19±0．69）mm]、[（43．14±9．87）％、（53．37±10．20）％]、[（57．17±11．20）％、（71．54±13．84）％],差异均具有统计学意义（P〈0．05）。结论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方案。     

冠状动脉造影三维重建与造影平面定量对比分析

目的研究冠状动脉造影三维重建定量分析冠状动脉狭窄病变的准确性，并与传统冠状动脉造影平面图像比较。方法收集2006年9月至200／年3月于解放军总医院接受冠状动脉造影和冠状动脉血管内超声检查（IVUS）的20处血管段（19例患者）的影像资料。以IVUS为参照，回顾性分析比较冠状动脉三维重建和传统平面图像对狭窄病变血管段最窄处管腔直径／面积、参考血管直径／面积、最窄处截面积狭窄率等的测量值。结果全部20处病变中，在三维重建和平面图像两种测量方法与IVUS各参数值差异无统计学意义；进一步分成偏心斑块组和向心斑块组，向心斑块组中三者测量值差异仍无统计学意义，而在偏心斑块组中冠状动脉三维重建对病变狭窄率测量比传统平面图像更准确（两组病变血管最窄处面积狭窄率为56．42％±11．02％比43．69％±21．41％，P〈0．05）。结论冠状动脉造影三维重建能够准确定量分析冠状动脉狭窄病变，对偏心性狭窄病变的准确性比传统造影平面图像更高。