冠状动脉介入治疗术中冠状动脉壁内血肿的血管内超声评价

Intravascular ultrasonic diagnosis of coronary artery intramural hematomas during percutaneous coronary interventions

目的:探讨血管内超声(IVUS)评价冠状动脉介入治疗术中冠状动脉壁内血肿的价值。方法:对17例经血管内超声诊断为冠状动脉壁内血肿的患者进行回顾和总结,分析其血管横断面及长轴观的影像学特征。结果:IVUS显示冠状动脉壁内血肿的短轴观呈新月形或环形,呈等于或稍强于血液的斑点状回声,长轴观显示为中膜内或中膜与外膜之间长度不等的占位,形态或直或扭曲,呈接近血液回声或稍强回声。血肿压迫血管腔可形成不同程度梗阻。结论:血管内超声是诊断冠状动脉壁内血肿或出血的准确、直观的方法,可清晰显示壁内血肿的空间方位及形态特征,对临床诊治具有指导意义。

Objective： To explore the value of intravascular ultrasound （IVUS） in diagnosing coronary artery intramural hematomas（IMH） during percutaneous coronary interventions. Methods： The IVUS findings in 17 cases of coronary artery IMH were analysed. Results： IVUS revealed that the cross-section views of coronary artery IMH appeared as a homogeneous, hy- perechoic, crescent-shaped or circular area within media or between media or EEM, and the long axis views of IMH presented unbent or tortuous homogeneous space-occupying lesions with varied length. IVUS showed hyperechoic or equal echogenic of the hematoma. The obstruction was caused by an extraluminal echolucent or echo-dense mass encroaching the vessel lumen, and without a dissection flap. Cortdusion： IVUS is an accurate and direct examination technique, with which the location and shape of post-angioplasty coronary artery IMH can be clearly shown. All these signs have important value for clinical diagnosis and treatment.