血管内超声技术对冠心病介入性诊疗中临床价值的研究

The Importance of Intravascular Ultrasound on Percutaneous Cornary Interventions in patients with Coronary Heart Disease

目的 :探讨血管内超声 (IVUS)在冠状动脉粥样硬化诊断、指导及评价经皮冠状动脉介入 (PCI)中的作用。方法 :对 10 6例行冠状动脉造影 (CAG)患者的 15 2处冠状动脉血管段于支架置入术前、 6 7处血管段于术后及 2 1处于高压球囊扩张后进行IVUS检测。结果 :IVUS在显示血管壁的形态结构、斑块的性质方面敏感性高于CAG检查 ,诊断冠心病更准确 ,血管造影低估冠脉病变的严重程度 ;本组15 2处血管 ,经CAG和IVUS检查符合介入治疗干预指征的血管 6 7处 ,IVUS指导置入支架的大小、长度以及置入的位置 ,支架置入术后 ,血管总截面积、管腔面积增加 ,斑块面积及面积狭窄率降低 ;高压球囊扩张前后斑块面积差异无显著性 ,血管总截面积、管腔面积、面积狭窄率有显著性差异。结论 :IVUS诊断冠心病的敏感性和特异性均为 10 0 % ,IVUS是诊断冠心病的金标准 ;IVUS能准确选择支架置入的适应症、帮助选择支架大小 ,支架置入后可精确评价支架扩张是否充分。

Objectives To compare the diagnostic values between coronary angiography （CAG）and intravascular ultrasound （IVUS）, to instruct the operation processes and evaluate the effect by IVUS. Methods The 152 coronary segments of 106 patients were studied after CAG before stenting operation, 67 segments after stenting and 21 segments after high-pressure ballon re-expansion by IVUS. Results IVUS appeared to be more sensitive for visualizing the shape and transmural components of the artery wall and characteristics of atherosclerotic plaques than CAG. The severity of coronary atherosclerosis was underestimated by CAG. 67 segments were indicated for operation by IVUS. Post-stenting in 67 segments was checked with IVUS. 46 segments had good effect and 21 segments with noideal effect needed high-pressure ballon re-expansion. This 21 segments with reexpansion were shown good effect by IVUS. Statistic analysis showed VA and LA were increased after post-stenting. PA and area stenosis rate （ASR）were reduced. VA and PA had no difference, but LA and ASR had obvious difference between prehigh pressure and posthigh pressure baUon re-expansion. Conclusion IVUS can be used to diagnose coronary atherosclerosis exactly. IVUS can be used to select the stenting indication and the size of stenting exactly. IVUS can accurately visualize the situation of stent expansion in deployment stent. Post-stenting vessels showed bad effect can be improved some what by high-pressure ballon re-expansion. IVUS was an important and useful tool in assessment of deployment stent with coronary artery disease.