远端血管弹性对冠状动脉慢性完全闭塞病变开通后无复流的影响

目的利用血管内超声(IVUS)评价冠状动脉远端血管弹性对慢性完全闭塞(CTO)病变开通后出现无复流或血流减慢的影响。方法回顾性分析2017年10月至2018年12月在首都医科大学附属北京安贞医院急诊中心行经皮冠状动脉介入治疗并成功置入支架完成IVUS检查的CTO病变患者34例。支架置入后远端血流正常组26例[心肌梗死溶栓治疗试验(TIMI)血流分级≥Ⅱ级],血流减慢组8例(TIMI血流分级0级或Ⅰ级)。分析可能导致无复流的病变形态学特点。结果两组患者血管钙化、中膜血肿、导丝行走于内膜下等比较,差异均无统计学意义(均P>0.05)。血流正常组的远端参考管腔面积[(4.09±1.71)mm2比(2.70±0.86)mm2,P=0.036]、远端血管收缩面积比[(15.96±3.95)%比(7.26±1.62)%,P=0.020]显著高于血流减慢组。logistic回归分析显示,远端血管弹性差(OR 13.75,95%CI 1.946~97.178,P=0.009)是支架置入后远端无复流及血流受限的独立预测因素。结论IVUS观察的CTO病变远端血管弹性是影响CTO病变开通后远端出现无复流的独立危险因素。

Impact of coronary distensibility for the no-reflow after percutaneous coronary intervention in patients with coronary chronic total occlusion

Objective To investigate the impact of coronary distensibility evaluated by intravascular ultrasound(IVUS)for no-reflow after percutaneous coronary intervention(PCI)in patients with chronic total occlusion(CTO).Methods Thirty-four CTO patients successfully performed PCI guided by IVUS in the Emergency Department in Anzhen Hospital were included between October 2017 to December 2018.Patients were divided into normal flow group(n=26)and no-reflow group(n=8).Vessel characteristic evaluated by IVUS were analyzed to evaluate the impact factor for no-reflow.Results The distal reference area in normal flow group was significantly larger than that in no-reflow group[(4.09±1.71)mm2 vs.(2.70±0.86)mm2,P=0.036].The percent of distal vessel systolic area was larger than that in the no-reflow group[(15.96±3.95)%vs.(7.26±1.62)%,P=0.020].Logistic regression analysis showed that the poor of distal vessel distensibility(OR 13.75,95%CI 1.946–97.178,P=0.009)was an independent predictor for no-reflow.Conclusions The distal vessel distensibility is an independent predictor for no-refl ow of CTO after PCI.