64排CT冠状动脉斑块分析对冠状动脉直接支架术指导作用的研究

Study of the value of coronary artery plaque analysis by 64 slice CT coronary angiography for direct coronary artery stenting in coronary artery disease

目的 探讨64排CT冠状动脉斑块分析对冠状动脉直接支架术的指导意义.方法 连续入选接受64排CT冠状动脉成像（CTA）并冠状动脉直接支架术治疗的患者42例,置入支架44枚.根据支架释放后有无残余狭窄分为2组,组间对比64排CT冠状动脉成像所示斑块的性质、斑块的CT值、钙化长度、横断面最大钙化面积.结果 残余狭窄组患者斑块的最大CT值大于无残余狭窄组（P＜0.01）.Logistic回归分析显示,当斑块的CT值达到648～679时,支架释放时出现残余狭窄的概率为70％～90％.结论 冠状动脉直接支架术支架释放后出现残余狭窄与斑块的最大CT值有关,当斑块有明显大的CT值时,采用直接支架术需谨慎.

Objective To explore the value of analysis of coronary artery plaque by 64 slice CT coronary angiography for guiding of coronary artery stenting. Methods 42 consecutive patients undergone 64 slice CT coro- nary angiography and treated with direct coronary artery stenting were enrolled. 44 stents were implanted. The patients were divided into two groups according whether the ramnant stenosis existed（underexpansion and non-under- expansion group） after stent expansion. Lesion composition, CT value, length and maximal area of calcium were compared between the two groups. Results The maximal CT value was larger in patients with stent underexpan- sion than in those without stem underexpansion. When the CT value was 648-676, calculated by Logistic regres- sion model, the probability of stent underexpansion was 70%-90%. Conclusion This study suggests that the stent underexpansion after direct stenting relate to the maximal CT value of lesion, and it should be careful to use the strategy of direct stenting to the lesions with overly large CT value.