64排CT对冠状动脉临界病变治疗决策的指导意义

Efficacy of 64-slice CT coronary angiography for treating coronary intermediate lesion

目的探讨64排CT测定冠状动脉斑块CT值,对于指导冠状动脉临界病变介入治疗的意义。方法选择经64排CT检查提示冠脉狭窄在50%～70%的临界病变,且斑块CT值为(14±26)HU,脂核体积>40%的冠心病患者120例,随机分为介入组及药物组,于治疗开始后10～12个月复查64排CT,随访并记录两组心脏不良事件。结果介入组46例及药物组45例在术后10～12个月进行了64排CT复查,介入组全部患者均未发现局部支架内血栓征象,但2例支架内再狭窄>50%,5例支架内轻度狭窄;药物组6例管腔狭窄加重至85%,与治疗前有明显差异,25例斑块CT值增加至(70±12)HU,2例变为钙化斑块,10例治疗期间因心绞痛加重行冠脉支架术,3例因急性心肌梗死急诊行冠脉支架术。结论 64排CT测定斑块CT值有助于判明冠状动脉临界病变是否需介入干预。

Objective To evaluate the efficacy of 64-slice CT coronary angiography for treating coronary intermediate lesion.Methods 120 patients whose coronary stenosis degree ranged from 50% to 70%（intermediate lesion） with CT values of lesion plaque being（18±26） HU and fat volumes larger than 40% determined by the 64-slice CT examination,were enrolled and randomly assigned into interventional therapy group（60 cases） and pharmacotherapy group（60 cases）,and the treatment effects of coronary intermediate lesion between interventional therapy group and pharmacotherapy group were compared and the results of follow-up 10 to 12 months after the surgery were analyzed.Results Forty-six patients in interventional group underwent the 64-slice CT examination during 10 to 12 months after the surgery,and the results were as follows： no patient with thrombus symptoms in local stent,2 patients with stent restenosis（the loss of the inner diameter of stent at late period larger than 50%） and 5 patients with stent intimal hyperplasia（different degrees of luminal stenosis）.Forty-five patients underwent 64-slice CT examination during 10 to 12 months after discharge in pharmacotherapy group.Among them,6 patients were found to be with luminal stenosis aggravated to 85% with significant difference as compared with that of prior to the treatment;no obvious changes were found in the 29 patients with luminal stenosis;10 patients were found with lumen size slightly enlarged;25 patients were found with CT value of plaque increased to（70±12） HU.Of the 60 patients in the pharmacotherapy group,10 patients underwent coronary stenting due to the aggravating angina,and 3 patients underwent coronary stenting due to acute myocardial infarction.Conclusions 64 slice CT for determining CT value of plaque is a helpful means in determining the necessity of intervention.