血管内超声在冠状动脉分叉病变分型中应用的探讨

Application intravascular ultrasound the classification of coronary bifurcation lesions

目的探讨血管内超声(IVUS)在冠状动脉分叉病变分型中的价值。方法经冠状动脉造影(CAG)确定的53例患者,共62处冠状动脉分叉病变,除常规CAG检查外,均行IVUS检查,根据主支(MV)和分支(SB)开口的斑块特点和分布进行病变类型的归纳与分类。结果分叉部位93.55%的MV斑块和98.39%的SB血管开口病变为偏心性斑块,斑块最大厚度呈相向存在或外侧壁分布的比例为77.42%。分叉部位共有6种主要病变类型:A型,MV偏心斑块位于SB开口对侧,SB开口的偏心斑块位于分叉脊对侧,占90.32%;B型,MV有向心斑块但未累及SB开口,SB开口的对侧主支上有斑块,占1.61%;C型,MV有向心性斑块并累及SB开口,SB开口的偏心斑块位于分支侧分叉脊的对侧,占1.61%;D型,MV有向心性斑块并累及SB开口及分叉脊的主支侧,占3.23%;E型,MV的偏心斑块位于SB开口对侧,SB血管开口有向心性病变,占1.61%;F型,MV的偏心斑块最大厚度位于SB侧,且斑块累及SB开口及分叉脊的主支侧,占1.61%。累及到分叉脊处的病变仅6.45%。结论冠状动脉分叉病变的IVUS分型不同于传统的CAG分型。病变的偏心性和外侧壁分布以及分叉脊的低病变率是IVUS分型的主要特点。

Objective To verify the application of intravascular ultrasound （IVUS） in the classification of coronary bifurcation lesions. Methods There were 62 coronary bifurcations verified by CAG. Additional to conventional CAG, all patients received IVUS exam. Observation and determination of the plaque position in the main vessel （MV） and the side branches （SB） was made as well as the plaque morphological characters in these bifurcations. Results A 93.55% of the MV and 98.39% of the SB plaque at the bifurcation were eccentric and 77.42% of the plaques located at the external side of the vessel wall of both the MV and SB. There were 6 types （Type A,B,C,D,E,F） of bifurcations classified by IVUS in this study. Type A （90. 32% ） was eccentric plaque in the MV which located at the opposite site of SB with the plaque in SB located at the opposite site of carina. Type B （ 1.61% ） was concentric plaque found only in MVwith no plaque in the SB. Type C （ 1.61% ） was concentric plaque in MV with eccentric plaque in SB which sited at the opposite of the carina. Type D （3.23%） was concentric plaque in MV which involved both of the ostium and the carina of SB. Type E （ 1.61% ） was eccentric plaque in MV which located at the opposite side of SB which has concentric plaque at ostium. Type F （ 1.61% ） was eccentric plaque in MV located at its the internal wall and involved carina of MV. A total of 6.45% of the all the lesions involved carina of the bifurcation. Conclusion Classification of coronary bifurcation based on IVUS was different from conventional CAG classification. The main IVUS classification criteria include ubtact carina, eccentricity and distribution of plaque on the external side of the vessel wall.