血管内超声在冠状动脉介入诊治中的运用

目的观察运用血管内超声(Intravascular ultrasound IVUS)测定冠脉病变血管的价值及安全性。方法30例冠心病患者,共46支冠状动脉血管在冠状动脉造影(Coronary angiography CAG)后行IVUS检查。IVUS测量狭窄段血管直径和截面积、斑块性质,与相应部位定量的冠状动脉造影(Quantitative coronary angiographyQCA)的结果比较。结果QCA检出偏心性狭窄25处(54.3%);IVUS检出偏心性狭窄32处(69.6%)(P<0.05)。IVUS发现30处(65.2%)靶血管病变钙化,而CAG检出18处(39.1%)血管病变钙化(P<0.01)。CAG和IVUS检出病变血管直径狭窄率分别为62.15%和74.35%(P<0.01)。46处(100%)靶血管完成IVUS检查,34处血管介入后复查,其中1处IVUS导管无法通过支架,IVUS检出不理想支架释放8处(24.2%)。所有患者随访1个月以上,未发现严重心脏缺血事件。结论IVUS可以准确地识别冠状动脉管腔形态、斑块性质,有助于冠脉介入手术策略的选择,是对CAG的有效补充,IVUS检查本身比较安全。

The Application of Intravascular Ultrasound in Percutaneous Coronary Intervention

Objective To explore the application of intravascular ultrasound(IVUS) imaging in assessing the characteristics of coronary lesion and guiding the percutaneous coronary intervention.Methods IVUS was used to assess the morphologic appearance of the vessel wall in 30 consecutive patients after coronary angiography.The mean age of these patients was 68.7±14.3 years.Among them,8 patients were female.IVUS with a motorized pullback system was performed in 46 segments of coronary vessel to assess the diameter of vessel,plaque character and the total vessel cross-sectional areas.The measurements of IVUS were compared with the results of quantitative coronary angiography(QCA).Results By QCA and IVUS examinating,among 46 segments measured the eccentric lesions were 25(54.3%) and 32(69.6%),respectively(P<0.05),the target vessel calcification was 18(39.1%) and 30(65.2%),respectively(P<0.01).The incidence of diameter stenosis was 62.15% and 74.35%(P<0.01).IVUS was successfully performed in all 46 target vessels.All vessels but one were passed the re-examed,the only one was failed to pass IVUS catheter.8 segments(24.2%) with non-optimal stent deployment needed high pressure ballon re-dilatation.All patients were follow-up for one month and found no major adverse cardiac events.Conclusions IVUS can accurately assess morphologic appearance of coronary vessel wall and the characteristics of plaque.IVUS has shown to be a safe and efficient procedure for strategic adaptations during percutaneous coronary intervention.