血管内超声在冠状动脉临界病变诊断和介入治疗中的应用

Application of Intravascular Ultrasound on Diagnosis and Treatment in Patients With Coronary Artery Intermediate Lesions

目的:探讨血管内超声(IVUS)在冠状动脉(冠脉)造影显示的临界病变诊断和介入治疗中的应用价值。方法:对经选择性冠脉造影提示临界病变的96例患者的110处病变进行IVUS检查,根据IVUS测定的最小管腔面积≤4.0 mm2作为冠脉介入治疗的标准,分为干预组和未干预组,分析病变的狭窄程度及粥样硬化斑块性质。结果:110处临界病变的平均最小管腔面积为(4.83±2.24)mm2,46处最小管腔面积≤4.0 mm2的病变成功置入冠脉支架;IVUS显示干预组的最小管腔面积小于未干预组(3.47±0.44)mm2比(5.69±1.57)mm2,(P<0.05);同时干预组的斑块负荷大于未干预组,但差异无统计学意义(68.50±5.98)%比(62.89±7.69)%,(P>0.05)。两组的定性结果差异无统计学意义(P>0.05)。结论:对冠脉造影显示的临界病变行IVUS检查可进一步明确临界病变的狭窄程度和病变的性质,指导下一步治疗。

Objective： To investigate the clinical application value of intravascular ultrasound （IVUS） on diagnosis and treatment in patients with intermediate atherosclerotic lesions found by coronary angiography. Methods：There were 110 coronary artery segments with intermediate stenosis found by coronary angiography in 96 patients, all patients received IVUS examination. The stenosis rate and the characteristics of atherosclerosis plaques were analyzed. Patients were divided into two groups, Intervention group, patients had minimal lumen area （MLA） of intermediate lesions ≤4. 0 mm^2 by IVUS who received percutaneous coronary intervention （ PCI）, and Non-intervention group, patients bad MLA 〉 4.0 mm^2 who received medication. Results ： The average MLA of 110 intermediate lesions was （4. 83±2. 24 ） mm^2. 43 patients with 46 MLA of the intermediate lesions ≤4.0 mm^2 received PCI. IVUS presented that MLA in Intervention group was smaller than that in Non-intervention group （3.47±0. 44）mm2 vs. （5. 69±1.57）mm2 ,P 〈0. 05. The quantitative results in both groups were similar, P 〉0. 05. Conclusion：IVUS could demonstrate the stenosis rate and the characteristics in patients with coronary artery intermediate lesions and provide the guidance for PCI strategy.