血管内超声在冠状动脉病变诊断及治疗中的应用价值

The use of Intravascular ultrasound in patients with Coronary Artery Disease after Percutaneous Cornary interventions

目的 探讨血管内超声(IVUS)检查在轻中度冠脉病变诊断及治疗中的价值。方法 对56例临床诊断为冠心病(CHD)的患者行冠状动脉造影(CAG)及IVUS检查。结果 ①56例共83处血管段,CAG示钙化性斑块12处,IVUS示钙化性斑块42处(P<0.01)。CAG示偏心性斑块25处,IVUS示偏心性斑块58处(P<0.01)。CAG示面积狭窄率为(55.09％±6.74％),IVUS示面积狭窄率为(72.00％±5.87%),P<0.05。②IVUS与CAG示面积狭窄程度呈正相关(r=0.63,P<0.01)。③CAG显示56例83处血管段均未达到支架置入指征,IVUS检测43处血管段需置入支架。④CAG显示43处血管段手术效果均理想,IVUS显示5例内膜撕裂严重者需进一步处理。结论 IVUS对于冠状动脉轻中度的诊断和介入治疗有较高的价值,且优于CAG。

Objective To assess the value of intravascular ultrasound (IVUS) and coronary angiography (CAG) in diagnosis and management of the coronary heart disease(CHD) . Methods 56 patients with CHD were studied after CAG and IVUS. Results A total of 83 segments in 56 patients were measured. 12 calcium plaques of 83 segments were detected using CAG,and 42 ones of 83 segments were detected using IVUS(P<0. 01). There were eccentric plaques in 25 of 83 segments by CAG,and in 58 of 83 segments by IVUS(P<0. 01). Mean maximal arterial area narrowing (72. 00%±5. 87%) measured by IVUS was more significant compared with that (55. 09%±6. 74%) by quantative angiography (P < 0. 05). The correlation between the two mean maximal arterial area narrowings measured by CAG and IVUS respectively was moderate (r = 0. 63,P<0. 01). 0 of 83 segments was indicated for stenting using CAG,and 43 of 83 segments indicated for stenting using IVUS. CAG could show clearly the artery contour for evaluating the operation effect,while IVUS could obviously reveal the intima dissections which needed further treatments. Conclusion There is a significant underestimation of mildly diseased coronary arteries by CAG compared with IVUS. IVUS can be used in the diagnosis and management of coronary atherosclerosis.