冠状动脉前降支近段临界靶病变的血管内超声影像学特点研究

Characteristics of intravascular ultrasound image of target borderline lesion in the proximal left anterior descending artery

目的 研究前降支近段临界靶病变的血管内影像特点,为治疗该类病变提供依据。方法 收集2010年6月至2011年10月沈阳军区总医院诊治的10例冠心病患者,造影显示前降支存在临界病变,直径狭窄程度30%-50%,其中男性7例,10例患者均有不同程度的心前区不适感,同时伴有糖尿病者2例,高血压者3例,高胆固醇血症者1例,有吸烟史者2例,既往有心肌梗死病史者2例。对症状典型的患者,行血管内超声检查,明确斑块分布情况后行介入治疗,对症状不典型的患者,先行运动负荷试验,阳性者血管内超声检查后行介入治疗。结果 10例经介入治疗患者临床症状均消失,最小血管管腔面积为（4.85±1.49）mm^2,其中大于4 mm2共7例,占70%;斑块面积负荷为（69.99±7.07）%,其中小于70%共4例,占40%。结论 在前降支近段,以最小管腔面积4 mm^2或斑块面积负荷70%作为判断是否应行介入治疗的界值是不可靠的,血管内超声检查结果结合患者临床情况有助于准确选择治疗策略。

Objective To investigate the characteristics of intravascular ultrasound（IVUS） image of target borderline lesion in the proximal left anterior descending artery （LAD） for finding the basement to treating these patients with the lesions. Methods The borderline lesions with 30% -50% dimension stenosis in the proximal LAD were found in 10 patients with coronary artery disease from June,2010 to October,2011. All the 10 patients had some discomfort in the precordium, including 7 males, 1 with diabetes,3 with hypertension, 1 with hypercholesterolemia,2 smokers and 2 with infarct history. The intervention was done in the patient with the typical syndrome after IVUS for identify the distribution of plaque in the proximal LAD. For the atypical patients, the exercise test was done firstly. The intervention was done in the positive patient after IVUS. Results The discomfort in the preeordium disappeared in all the 10 patients. The minimal lumen area （MLA） of them in the proximal LAD was （4. 85±1.49 ）mm^2. MLA in the 7 patients was more than 4 mm^2. The area stenosis （AS） of them in the proximal LAD was 69.99% ± 7.07%. AS in the 4 patients was less than 70%. Conclusion In the proximal LAD,it is unreliable that 4 mm^2 of MLA or 70% of AS was considered to the cut-off value for the intervention therapy. The suitable strategy to the patients with borderline lesion in the proximal LAD should come from the combination of IVUS