血管腔内超声对冠状动脉造影显示的临界病变介入治疗的价值

Clinical application value of intravascular ultrasound in the diagnosis and treatment for intermediate lesions showed by coronary angiography

目的探讨血管腔内超声显像(IVUS)在冠状动脉造影(CAG)显示的临界病变介入治疗中的临床应用价值。方法54例冠心病患者应用IVUS检测到62处病变血管的总截面积(TVA)、最小管腔截面积(MLA)、面积狭窄百分比(%AS)、参照血管直径(RLD)、血管直径(VD)、最小管腔直径(MLD)及直径狭窄百分比(%DS),并测量相应CAG所显示的RLD、MLD、%DS和%AS。根据IVUS检查结果按是否行介入治疗进行分组,介入组26例30处病变和非介入组28例32处病变。介入组检测支架置入前后的上述检测指标。结果CAG显示的MLD、%DS和%AS均低于IVUS的检测值(P<0.05);CAG仅显示管腔外在形态学变化,IVUS则能明确显示斑块的性质及病变的严重程度。介入组平均面积狭窄率为71.4%,符合介入治疗指征,与非介入组的39.6%相比差异有统计学意义(P<0.05);同时,应用IVUS观察了介入组置入支架前后测值变化,除TVA、VD无明显变化外,其余的MLA、%AS、MLD及%DS指标差异均有统计学意义(P<0.05)。结论对CAG显示的临界病变行IVUS检查可了解血管壁内在组织形态学变化和病变程度,实时指导治疗方案的选择和手术过程,其效果优于CAG。

Objective To investigate the clinical application value of intravascular ultrasotmd （IVUS） in the diagnosis and treatment for intermediate atherosclerotic lesions showed by coronary angiography（CAG）. Methods /VUS was performed in 62 lesions of 54 patients, the total vessel area（TVA） ,minimal lumen area （MLA）, area stenosis （ % AS）, reference lumen diameter （RLD）, vessel diameter （VD）, minimal lumen diameter （MLD） and diameter stenosis （ % DS） were measured. Interventional therapy was performed based on the IVUS and clinical findings. The IVUS parameters and morphological characteristics were compared between 26 lesions in 30 patients with intervention therapy and 28 lesions in 32 patients without intervention therapy. In patients with standing, the IVUS parameters before and after standing were compared. Results CAG showed that the MLD, % DS and % AS were significantly lower than those obtained by IVUS （ P 〈 0.05）. CAG could only demonstrate the morphological characters of the arterial lumen, while IVUS could reveal the characteristics of the lesion on the vessel wall at the same time. The intervention group had more severe stenosis with mean %AS of 71.4%, consistent with the indication of percutaneous coronary intervention （PCI） and the % AS was significantly higher than that in patients without intervention therapy （39.6%, P 〈 0.05）. Meanwhile, the parameters before and after standing were measured by IVUS. The MLA, % AS, MLD and % DS after standing were significantly higher than those before intervention therapy （ P 〈 0.05）, however, there were no significant changes in TVA and VI） （ P 〉 0.05）. Conclusion IVUS is superior to CAG in the assessment of the intermediate lesions, since which could demonstrate the characteristics of the lesion, and could provide guidance for the treatment plan and evaluate the interventional results.