血管内超声波法指导及评价冠状动脉支架置入的研究

目的:探讨血管内超声波法(IVUS)在指导及评价高压球囊扩张支架置入术中的作用。方法:对2002年1月~2002年12月收治的50例58处冠状动脉(冠脉)病变行支架置入术时进行冠脉造影(CAG)及IVUS检查,IVUS指导选择支架的适应证及支架的大小,当达到CAG理想的支架置入标准时,置入支架并应用IVUS进行评价,观察支架是否充分扩张,血管扩张未达到IVUS的理想标准者再次行高压球囊扩张。结果:支架置入后仅35处(60.3%)符合IVUS理想支架置入标准,23处(39.7%)支架未达到IVUS理想置入标准,再次经高压球囊扩张后全血管面积(VA)及最小血管内膜腔面积(MLA)明显增加,斑块面积(PA)减小,病变均达到CAG理想的支架置入标准。结论:采用高压球囊扩张支架置入术,并不能使支架完全达到理想的扩张状态,IVUS指导下的高压球囊扩张可进一步改善支架置入效果,是目前指导及评价支架置入效果的最佳手段。

Instruction and Assessmention of Intravascular Ultrasound in Intracoronary Stent Implantation

Objective:To instruct the operation processes and evaluate the effect of stent implantation by intravascular ultrasound(IVUS)Methods:The 58 coronary stents of 50 patients were studied .IVUS were used to select the stenting indication and the size of stenting exactly.IVUS were performed in all cases to evaluate stent apposition,symmetry,and lumen dimension after optimal angiography results were reached.If optimum stent deployment was not met of IVUS .additional high pressure dilatation would be performed until optimal criteria of IVUS were met .Results:After initial high pressure dilatation,VA ane MLA were significant increased,58 stents achieved optimum stent deployment by criteria of CAG.Only 35(60.3%) stents had good effect and achieved optimum stent deployment by optimal criteria of IVUS.23(39.7%) stents with no ideal effect needed additional high-pressure balloon re-expansion.This 23 stents with reexpansion were shown good effect by IVUS.There were serious residual plaque burdens in all patients after stents deployment with high pressur.Conclusion:Despite with moderately high pressure deployment,stent implantation was not satisfied.Additional high pressure under IVUS guidance can achieve optimizing stent deployment .IVUS can accurately visualize the situation of stent expansion in deployment stent.IVUS was an important and useful tool in guidance and assessment of deployment stent.