血管内超声指导急性冠状动脉综合征患者药物洗脱支架置入的研究

Application of intravascular ultrasound in drug-eluting stent implantation in patients with acute coronary syndrome

目的探讨血管内超声(IVUS)指导药物洗脱支架置入的价值。方法对38例急性冠状动脉综合征患者67处病变行IVUS检查,指导药物洗脱支架置入。置入后再行IVUS,对未达到理想释放者进行高压球囊后扩张。观察6个月主要不良心脏事件。结果首次常规高压扩张置入支架,67处病变均达到冠状动脉造影理想标准,但符合IVUS理想标准仅40处(59.7%),27处(40.3%)未达标;行高压球囊后扩张,又有21处达到IVUS理想标准。最终达到IVUS理想标准者与常规高压扩张后比较,差异有统计学意义(91.0%对59.7%,P<0.0001)。随访期间无一例心源性死亡或再梗死,再发心绞痛2例(5.3%)。结论常规高压球囊扩张置入药物洗脱支架,并不能使所有支架达到IVUS理想标准。IVUS指导下高压球囊后扩张可进一步改善药物洗脱支架置入效果,具有重要临床价值。

Objective To investigate the significance of intravascular ultrasound （IVUS） in drug-eluting stent implantation in patients with acute coronary syndrome （ACS）. Methods IVUS was applied to evaluate 67 lesions of 63 coronary arteries in 38 patients and drug-eluting stent deployment. If IVUS criteria of optimal stent deployment were not met, post-dilatation with noncompliant balloons at higher pressure and reassessment with IVUS were performed. Major adverse cardiac events （cardiac death, reinfarction, recurrent angina and revascularization） during follow-up of six months were observed. Results Optimal angiographic criteria were achieved in all lesions after stenting with conventional high-pressure dilatation, but optimal criteria of IVUS were only obtained in forty lesions （59.7 %）. Twenty-seven lesions （40.3 %） failed to achieve optimal criteria of IVUS and were treated with post-dilatation with 16 to 20 atm, then twenty-one lesions obtained the optimal criteria of IVUS. The frequency of achieving optimal criteria of IVUS increased from 59.7% to 91.0% （P 〈 0.0001）. There were two patients of recurrent angina（5.3%）, and no death and reinfarction were observed during follow-up. Conclusions All drug-eluting stent deployment under moderately high-pressure inflation could not achieve optimal criteria of IVUS. And post-dilatation with IVUS guidance could improve effects of intervention. Stenting with IVUS guidance is safe and effective.