血管内超声指导冠状动脉介入治疗的疗效

Comparative study of intravascular ultrasound and coronary angiography in percutaneous coronary intervention therapy

目的比较血管内超声（IVus）及冠脉造影两种方法测量病变血管的直径及直径狭窄率，评价IVUs在冠脉介入手术适应证的选择、手术过程指导、手术效果的作用。方法连续性分析2013年5月至2014年5月在兵团第七师医院心血管内科心导管室行冠脉造影检查及行经皮冠状动脉介入（PCI）治疗的住院患者，89例IVUS指导组和90例冠脉造影指导组患者纳入研究，比较两组的近期及远期疗效。结果IVUS指导组测得最小血管直径（MI。D）较冠脉造影指导组小（P〈0．05），直径狭窄率（DS）与病变长度（LL）均较冠脉造影指导组显著升高（P〈0．05）。IVUS指导组中的钙化病变及偏心病变检出率也较造影指导组明显增高。IVUS指导组和造影指导组分别有204枚（93．6％）和195枚（87．8％）支架使用后扩张高压球囊，差异具有统计学意义。支架置人后两组相比较，IVus指导组的最小管腔直径及斑块负荷均较造影指导组改善明显（P〈0．05）。结论IVuS指导冠状动脉病变PCI治疗安全有效，可以对病变性质做出准确判断，及指导术中支架直径的选择及高压球囊的应用，能较造影指导组获得更大即刻管腔直径和较低的斑块负荷，无严重的近期或者远期的并发症。

Objective To compare intravascular ultrasound （IVUS） and coronary angiography in measuring the lumen diameter and coronary arteries stenosis rate, to investigate the impact of IVUS in the choice of surgical indications, surgical procedure guidance and effects of operation. Methods The patients who underwent percutaneous coronary intervention（PCI） therapy from may 2013 to may 2014 were divided into IVUS-guided intervention therapy group （n= 89） and coronary angiography- guided group （n= 90）. Their baseline parameters, lesion features, MACE and restenosis during follow-up were analyzed. Results Baseline clinical and angiographic characterisitcs were well matched and show no significant differences between the two groups. Compared to angiography-guided group, the minimum lumen diameter （MLD） of IVUS guided group were higher, diameter stenosis （DS） and lesion length （LL） were lower in IVUS-guided intervention therapy group . The detection rate of calcified and eccentric lesion were significantly higher in IVUS-guided group. There were 204 （93.6 %） and 195 （87.8 ~//00） high-pressure balloons used in post-inflation in two groups, respectively. The MLD and plaque burden of IVUS-guided group were obviously improved after stent implantation. Conclusions IVUS-guided intervention therapy in PCI is safe and effective, may be helpful for the judgment of lesion, evaluating stent implantation and guiding high-pressure balloon post-inflation. IVUS-guided intervention could get the bigger immediate lumen diameter and lower plaque burden than coronary angiography without serious short-term or long-term complications.