支架影像增强显影指导冠状动脉开口病变介入治疗临床应用

Clinical application of enhanced visualization of the coronary stent by using stent boost subtract technique in guiding percutaneous coronary intervention for coronary artery ostial lesions

目的探讨数字平板血管造影机支架影像增强显影(SBS)技术在指导冠状动脉开口病变介入治疗中的应用效果。方法收集2012年3月至2014年10月期间武警部队总医院采用经皮冠状动脉介入治疗(PCI)的连续55例冠状动脉开口病变患者的临床资料,对58个开口病变植入支架前后作SBS检查和血管内超声(IVUS)验证。根据支架完全膨胀和精确定位相关标准评价SBS检查和IVUS验证结果。结果对比IVUS验证结果,SBS技术精确指导PCI手术中48个(48/58,82.8%)病变的支架定位,同时检测到8个(8/58,13.8%)病变为支架膨胀不全。SBS技术预测支架膨胀不全的特异度为100%,灵敏度为80%。SBS检测到的支架管腔最小面积(MSA)与IVUS验证的MSA呈明显正相关(r=0.95,P<0.001)。结论 SBS技术是一种简便易行、能精确提供植入支架定位及支架完全膨胀信息的方法,可常规应用于PCI术治疗冠状动脉开口病变,尤其适用于那些无法开展IVUS检查的临床中心。

Objective To discuss the application of stent boost subtract （SBS） technique of digital fiat panel angiography in guiding interventional treatment of coronary artery ostial lesions. Methods The clinical data of a total of 55 consecutive patients with coronary artery ostial lesion, who were admitted to General Hospital of Chinese People＇s Armed Police Forces during the period from March 2012 to October 2014 to receive percutaneous coronary intervention （PCI）, were included in this study. SBS inspection and intravascular ultrasound （IVUS） verification of 58 coronary artery ostial lesions were conducted before and after the stent implantation for ostial lesions. According to the related standard concerning the full expansion and precise position of the stent, the results of SBS inspection and IVUS verification were evaluated. Results Compared with the IVUS results of verification, SBS technique precisely guided the stent positioning for 48 lesions （82.8%） during the performance of PCI, meanwhile, incomplete expansion of stent was detected in 8 lesions （13.8%）. The specificity and sensitivity of SBS technique in predicting the incomplete expansion of stent were 100% and 80.0% respectively. Meanwhile, the minimum stent lumen area （MSA） detected by SBS showed a significant positive correlation with the MSA measured by IVUS （r=0.95, P〈0.001）. Conclusion SBS technique is a simple and accurate means to provide important information about the stent positioning and expansion. SBS can be routinely used in PCI for coronary artery ostial lesions; it is especially useful in those medical centers that are not able to carry out IVUS examination.