血管内超声对高压扩张冠状动脉支架置入的指导作用

High-pressure intracoronary stent implantation under intracoronary ultrasound guidance

目的 观察支架高压扩张后的血管内超声 (IVUS)结果 ,并用其指导支架置入 ,探讨IVUS在高压扩张时代的应用价值。方法 对 84处病变进行支架置入 ,当达到冠状动脉 (冠脉 )造影理想的支架置入标准时 ,应用IVUS进行评价 ,符合IVUS理想的支架置入标准的病变归入不需进一步干预组 (NAI组 ) ,不符合IVUS理想的支架置入标准的病变归入需进一步干预组 (AI组 )。在IVUS指导下对AI组进行进一步干预 ,直到符合IVUS理想标准或最大压力达到 2 0 2 6 5kPa。比较AI组在首次扩张后和最终的IVUS结果以及最终两组之间的结果。结果 在首次高压扩张后 ,有 4 9(5 8 3% )处病变 (NAI组 )的IVUS结果符合理想的支架置入标准 ,35 (4 1 7% )处病变 (AI组 )的IVUS结果未达到理想的支架置入标准从而进行了更高压力的进一步扩张。AI组经过更高压力扩张后 ,最终有 2 9(82 9% )处病变达到理想的支架置入标准。支架内最小横截面积由 (7 3± 2 0 )mm2 增加至 (9 3±2 0 )mm2 (P <0 0 0 1) ,急性获益由 (71± 15 ) %增加至 (91± 15 ) % (P <0 0 0 1)。结论 即使采用了高压扩张 (12 15 9～ 14 18 6kPa)技术 ,也不能确保达到满意的支架扩张。对于高压扩张后造影结果满意但IVUS结果不理想的病变 ,在IVUS指导下的更高压力 (16 2 1 2?

Objective To determine if stent deployment techniques are improved with intravascular ultrasound (IVUS) imaging despite an optimal angiographic result achieved with high-pressure balloon inflation. Methods From Dec. 2000 to Feb. 2002 prospective data were collected on seventy-six patients in whom eighty-four stents were deployed in eighty-four native coronary lesions. All patients were allocated to coronary stent implantation with high inflation pressure and underwent IVUS before and after initial high-pressure dilatation. High-pressure (≥1?215.9 kPa in all cases) balloon inflation were continued until angiographic completion (<10% residual stenosis), after which stent apposition, symmetry, and lumen dimension were evaluated with IVUS. If inadequate IVUS result was found, further dilations with higher-pressure or larger balloon and subsequent stent reevaluation with IVUS were performed until criteria for optimal coronary stent implantation were met or dilation pressure reached 2?026.5 kPa. Results Optimal criteria of IVUS were obtained in fourty-nine (58.3%) lesions (NAI group) after initial high-pressure dilatation and intrastent additional higher-pressure dilatation were performed in thirty-five (41.7%) lesions (AI group) whose ultrasound results did not reach the criteria. In patients requiring additional inflations [peak pressure from (1?419±172) kPa to (1?702±172) kPa, P<0.001], minimum stent area increased from (7.3±2.0) mm 2 to (9.3±2.0) mm 2 (P<0.001) and acute gain increased from 0.71±0.15 to 0.91±0.15 (P<0.001)in this group. Conclusion Stent implantation using high-pressure (1?215.9-1?418.6 kPa) technique does not guarantee adequate stent expansion. Additional higher-pressure (1?621.2-2?026.5 kPa) under intracoronary ultrasound guidance can achieve optimizing acute gain, symmetry, and apposition of intracoronary stents in 82.9% of the lesions that meet optimal angiographic criteria but do not meet IVUS standard. Additional higher-pressure (1?621.2-2?026.5 kPa) technique under intracoronary ultrasound guidance is safe and effective.