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。

Comparative study on intravascular ultrasound and quantitative coronary angiography in diagnosis and treatment of intermediate coronary stenosis

AIM To study the clinical value of intravascular ultrasound(IVUS) in diagnosis and treatment of intermediate lesions in airline pilots with coronary intermediate stenosis. METHODS The parameters of 165 coronary intermediate stenoses in 120 patients including minimum lumen diameter(MLD), diameter stenosis(DS), minimum lumen area(MLA) and area stenosis(AS) were evaluated and compared, respectively, by quantitative coronary angiography(QCA) and IVUS. Stent implantation was performed on patients with MLA <4 mm2 calculated by IVUS. RESULTS MLD, MLA, AS and DS by QCA were significantly lower than those by IVUS(P<0.01), indicating IVUS was more accurate in evaluating intermediate coronary stenosis. IVUS enhanced the diagnosis rates of thrombus(15.0% vs. 2.5%, P=0.05) and myocardial bridging(42.50% vs. 2.5%, P<0.01). IVUS was superior to QCA in showing stent placement and deployment. CONCLUSION In the diagnosis and treatment of intermediate stenosis, IVUS is superior in detecting the severity of intermediate stenosis, diagnosing thrombus and myocardial bridging and optimizing safer clinical treatment strategies.