有无血管内超声引导的冠状动脉直接支架术临床研究

Comparative study of direct coronary stenting with or without the guiding of intra-vascular ultrasound

目的 :比较有无血管内超声 (IVUS)引导的直接冠状动脉内支架术对临床预后的影响。方法 :回顾性分析了有无IVUS冠状动脉直接支架术的可能性和主要影响因素。结果 :研究显示 ,6 0 4例支架病人中 ,2 5 4例 ( 4 2 % )经过术者筛选的病例 ,尝试冠状动脉直接支架术 ,2 37例成功 ,74例行IVUS研究 ,其中IVUS证实的 17例失败病例 ,严重成角病变 6例 ,钙化病变 7例 ,纤维钙化病变 4例 ;另 86例病人 ,未考虑行IVUS研究 ,仅根据术者经验 ,直接接受了冠状动脉直接支架术 ,占同期病人的 5 6 % ,85例成功 ( 98 9% ) ;两组病人平均随访 2～ 2 1( 10 2± 5 2 )个月 ,住院期间并发症和长期预后 ,两组间未见明显区别。结论 :病变形态学及血管解剖特点是判断能否行直接支架术的重要因素。无IVUS引导下的冠状动脉直接支架术是可行的 ,临床预后与前期结果相同。对一个有经验的心脏介入医生筛选的病变 ,直接支架术是一个可行的安全手术 ,即使没有血管内超声引导同样能获得较好的临床效果。

Objective: To compare the effect of direct coronary with or without the guiding of intra-vascular ultrasound (IVUS) on clinical prognosis.Methods:Retrospectively analysed the possibility of direct coronary stenting with or withoout the guiding of IVUS and main affective factors of clinical prognosis.Results:Totally 254 of 604 stenting cases tried direct coronary stenting (42%),237 procedures were successful (93%),74 cases did IVUS study which included 17 failed patients for direct coronary stenting.Of 17 patients,6 patients had severe angled lesions, 7 patients had calcificed lesions, 4 patients with fibrous calcification lesions.Another 86 patients primarily did direct coronary stenting without the guiding of IVUS,only depending on the experience of cardiology interventionists,acounting for 56% of all intervention patients at the same period;85 of 86 cases was successful (99%).Two groups (direct stenting group=86 cases, standard stenting group =68 cases) were followed up about 10.2±5.2 mouths, complications during hospitalization and long term clinical prognosis did not show any difference detween two groups with or without the guiding of IVUS.Conclusion:Lesion norphology and anatomy characteristics were main affecting factors for direct coronary stenting,but direct coronary stenting can be primarily done depending on the experience of interventionists and it is not nevessary for IVUS before direct coronary stenting.Clinical prognosis for two groups was similar.