中等程度冠状动脉狭窄的血管内超声特点与治疗决策选择

Intravascular ultrasonographic characteristics and the choice of treatment strategy on moderate coronary artery stenosis

目的 应用血管内超声 (IVUS)观察冠状动脉造影中等程度冠状动脉狭窄的血管内超声特点 ,选择治疗决策。方法 应用血管内超声仪检查 3 8例血管造影狭窄程度 40 %～ 60 %患者的 43处冠状动脉病变 ;测量管腔以及血管直径和面积。结果 43处病变中 ,脂质斑块为 3 0处 ,纤维、钙化、混合斑块分别为 4、2、5处 ,2处未发现明显病变或仅轻度内膜增生 ;其中 4处可见明显血栓影。 41处粥样硬化斑块中偏心斑块 3 6处 ( 87.8% ) ,向心斑块 5处 ( 12 .2 % )。 3 0处脂质斑块大部分可见薄的纤维帽 ,其中 5处 ( 16.7% )明显的纤维帽不完整。病变血管直径狭窄百分比 ( 4 0 .73± 13 .2 1) % ;面积狭窄百分比 ( 5 6.75± 12 .68) %。对IVUS示面积狭窄 >5 0 %的 2 5处、<5 0 %的 1处 ( 60 .5 % )且有典型临床症状的病变行进一步介入治疗 ,对IVUS示面积狭窄 <5 0 %的 17处 ( 3 9.5 % )病变未行进一步介入治疗。结论 IVUS可进一步明确血管造影中等程度冠状动脉病变的性质、严重性和稳定性 。

Objective To investigate the characteristics of angiographically moderate coronary artery stenosis, and to determine how to choose appropriate treatment strategy using intravascular ultrasound (IVUS). Methods Forty-three coronary artery lesions with 40% to 60% stenosis in 38 patients were observed with intravascular ultrasound machine. The IVUS image was analyzed, the quality and characteristics were identified, the diameter and area of lumen and vessel were measured. At the same time, the stenosis percentage of diameter and area were acquired. Results Among 43 lesions there were 30 soft plaque, 4 fibrous plaque, 2 calcific plaque, 5 mixed plaque, and 2 had no obvious lesion or had mild intimal proliferation only; 4 lesions with obvious thrombus image. Among 41 atherosclerotic plaques, there were 36 (87.8%) eccentric plaques and 5 (12.2%) concentric plaques. Thin fibrous caps could be observed in most of the 30 soft plaques, among those, there were 5 (16.7%) plaques with obvious disintegral fibrous cap. Diameter stenosis percentage was (40.73± 13.21)% and area stenosis percentage was (56.75±12.68)% on lesion site. Further interventional treatment was performed in 25 lesions with area stenosis percentage >50% and 1 lesion with area stenosis percentage <50% (60.5%) with typical clinical symptom, while further interventional treatment was not performed in 17 lesions (39.5%) with area stenosis percentage <50%. Conclusion The quality, severity and stability of moderate coronary lesion observed by angiography can be further clarified, and further treatment strategy can be determined by IVUS.