冠脉内超声成像在冠状动脉内支架植入术中的应用

Assessment of deployment stent with intracoronary ultrasound

目的 探讨冠脉内超声成像 (ICUS)在冠心病支架植入术治疗中的作用。方法 对 88例经皮冠脉腔内成形术 (PTCA)同时行冠状动脉内支架植入治疗的患者进行评价。在支架植入前 ,应用ICUS测量病变血管的最小腔径和最小腔面积 ;在支架植入后 ,测量支架扩张后的最小直径和支架面积 ,确定扩张后支架是否贴壁和支架扩张是否充分。结果 88例支架植入术患者的 97枚支架ICUS结果 :植入后支架的平均直径为 (3 .12±0 .16 )mm ,平均面积为 (6 .85± 0 .76 )mm2 。其中 42例支架植入前后斑块面积的配对 t检验显示支架植入前后靶血管腔面积和斑块面积均有显著性差异 (P <0 .0 0 1)。扩张后的支架直径为 (3 .0 9± 0 .0 9)mm ,支架面积为(6 .75± 0 .6 7)mm2 。 8例支架未充分扩展 ,3例贴壁欠佳 ,行再次扩张 ,占支架植入患者的 12 .5 %。结论 冠脉内超声可清晰显示冠脉内支架 ,支架植入前可确定血管直径 ,帮助选择支架的大小 ;植入后可精确测量支架的大小和面积 ,同时可观察支架贴壁情况 ,评价支架扩张是否充分。冠脉内超声是目前指导支架植入 。

Objective To investigate the importance of intracoronary ultrasound (ICUS) in deployment stent of coronary artery disease.Methods Eightyeight patients with intracoronary stent deployment were consecutively examined by intravascular ultrasound system (Endosonics),and minimal luminal diameters, vessel diameters, cross section area and vessel area were measured before and after deployment of stent in 42 patients.Results The minimal luminal diameters and area were separately ( 3.12 ± 0.16 )mm and ( 6.85 ± 0.76 )mm2 in 97 stents of 88 patients. The minimal luminal diameters was ( 2.19 ±0.13)mm vs ( 3.09 ± 0.09 )mm and the cross section area was ( 4.29 ± 0.46 )mm2 vs ( 6.75 ± 0.67 )mm2 before and after stent therapy in 42 patients. The minimal luminal diameter and cross section area were significantly different before and after stent deployment (P< 0.001 ). The stents were not fully expanded in 8 patients and appressed to the wall of vessels in 3 patients.Conclusions ICUS can accurately measure the diameter and area of deployment stent ,and clearly visualize the situation of stent expansion and appressed to wall of vessel in deployment stent.ICUS was an improtant and useful tool in assessment of deployment stent with coronary artery disease.