血管内超声在自发性冠状动脉夹层诊断和治疗中的初步应用

Preliminary application of intravascular ultrasound in spontaneous coronary artery dissection

目的初步探讨血管内超声(IVUS)在自发性冠状动脉夹层(spontaneouscoronaryarterydissection,SCAD)诊断和介入治疗中的应用价值。方法采用IVUS观察6例SCAD的显像特征,并指导3例SCAD的冠状动脉内支架植入治疗。结果6例患者IVUS均清晰显示内膜片结构,根据真假腔外侧壁的超声结构差异和假腔内血栓,6例患者均成功鉴别出真假腔。3例接受冠状动脉内支架植入治疗的患者,根据IVUS显像准确选择支架尺寸,指导支架在真腔内释放,并确定支架扩张充分和夹层完全闭合。结论应用IVUS有助于对SCAD进行精确的评估,准确地指导SCAD的冠状动脉内支架植入并评价其疗效。

Objective To evaluate the role of intravascular ultrasound （IVUS） in the diagnosis and intervention of spontaneous coronary artery dissection （SCAD）. Methods IVUS imaging was assessed in 6 patients,and coronary stenting was guided by IVUS in three patients. Results In all the six patients,intimal flap was clearly observed by IVUS. The different laminar appearance of the outer walls of the true and false lumens, and thrombosis in the false lumen detected by IVUS, were used to differentiate the true from the false lumen successfully. In the coronay stenting of 3 SCAD cases, stent size could be determined by the diameter and length of the dissected coronary segment measured by IVUS. Moreover,IVUS could guide the stent deployment in the true lumen and ensure the stent was well-expanded and the false lumen was completely sealed after stenting. Conclusions IVUS can accurately evaluate SCAD,and provide the guidance for coronary stenting and evaluation of the therapeutic effect.