血管内超声用于外周动脉狭窄诊断、治疗的临床价值

Clinical value of intravascular ultrasound in diagnosis and treatment of peripheral arteriostenosis

目的评价血管内超声（intravascular ultrasound,IVUS）对外周动脉狭窄的诊断和血管内介入治疗的价值。方法选择2006年10月至2010年9月西南医院心内科诊断为外周动脉狭窄的住院患者94例,其中男性58例,女性36例,年龄26~77（58.4±18.3）岁。将患者分为数字减影血管造影（digital subtraction angiography,DSA）组（行DSA检查,43例）及DSA＋IVUS组（行DSA及IVUS检查,51例）,对2种检查结果进行比较。分别在DSA及IVUS指导下置入支架,并观察支架置入效果。术后采用普通超声、CTA随访,必要时再次行DSA及IVUS检查。结果 DSA＋IVUS组中DSA检测发现狭窄血管77处,其中偏心性狭窄42处,向心性狭窄35处;IVUS检测发现狭窄血管82处,其中偏心性斑块63处,向心性斑块19处。直径狭窄率IVUS所测值[（67.1±12.2）%]显著高于DSA[（54.5±11.4）%]（P〈0.05）。面积狭窄率IVUS所测值[（89.3±12.3）%]显著高于DSA[（77.1±13.1）%]（P〈0.05）。DSA＋IVUS组支架置入治疗82处血管病变,DSA组支架置入治疗53处血管病变,支架置入均获成功。经3~48个月随访,DSA组再狭窄率[15.1%（8/53）]显著高于DSA＋IVUS组[3.7%（3/82）（P〈0.05）]。结论 IVUS比DSA能更准确地判定病变性质及狭窄程度,更有效地指导和评估支架置入。

Objective To evaluate the clinical value of intravascular ultrasound（IVUS） in diagnosis and intravascular interventional therapy of peripheral arteriostenosis.Methods Ninety-four inpatients [58 males and 36 females,aged 26 to 77（58.4±18.3）] with peripheral arteriostenosis who received diagnosis and treatment in Southwest Hospital,China,from Oct.2006 to Sep.2010 were enrolled.The patients were divided into a DSA group [43 patients examined with digital subtraction angiography（DSA）] and a DSA＋IVUS group（51 patients examined with DSA plus IVUS）.The examination results were compared.Stents were implanted under the guidance of DSA and IVUS,and the stent implantation effects were observed.General ultrasound and CTA follow-up were carried out.DSA and IVUS examination were conducted after the operation if necessary.Results In DSA＋IVUS group,77 sites of stenotic vessels were detected with DSA,including 42 eccentric stenosis sites and 35 concentric stenosis sites;82 sites of stenotic vessels were detected with IVUS,including 63 eccentric plaques and 19 concentric plaques.The diameter stenosis rate measured with IVUS [（67.1±12.2）%] was significantly higher than that measured with DSA [（54.5±11.4）%]（P0.05）.The area stenosis rate measured with IVUS [（89.3±12.3）%] was significantly higher than that measured with DSA [（77.1±13.1）%]（P0.05）.Stent implantation was successfully used to treat 82 sites of angiopathy in DSA＋IVUS group and 53 sites in DSA group.After 3-to 48-month follow-up,the restenosis rate of DSA group（15.1%,8/53） was significantly higher than that of DSA＋IVUS group（3.7%,3/82）（P0.05）.Conclusion As compared with DSA,IVUS can judge pathological nature and stenosis severity more precisely,and can guide and evaluate stent implantation more effectively.