血管内超声对复杂冠状动脉左主干病变患者介入治疗的指导价值

Value of intravascular ultrasonography for PCI in patients with complicated left main coronary artery lesions

目的研究血管内超声(IVUS)对复杂冠状动脉左主干病变患者PCI的指导价值。方法收集2014年1月～2017年1月我科收治的复杂冠状动脉左主干病变并且行PCI的患者110例,分为对照组55例和观察组55例(PCI术中采用IVUS技术进行指导)。比较2组患者基本资料、最小管腔直径(MLD)、最小管腔面积(MLA)、面积狭窄率(AS)、支架直径及长度、支架释放压力、后扩张球囊压力及直径等指标;随访1年,观察2组靶病变血运重建和主要不良心脏事件(MACE)情况。结果观察组MLD[(2.17±0.36)mmvs (1.62±0.59)mm,P=0.000]、MLA[(4.94±1.61)mm^2 vs (2.51±1.77)mm^2,P=0.000]、支架直径[(3.54±0.24)mmvs (3.34±0.31)mm,P=0.002]、支架长度[(14.41±5.25)mmvs (12.11±4.21)mm,P=0.038]、后扩张球囊直径[(3.98±0.51)mmvs (3.77±0.38)mm,P=0.040]、后扩张球囊压力明显大于对照组(P=0.000),AS明显低于对照组[(63.23±8.17)%vs (77.31±7.42)%,P=0.000)];随访期观察组总MACE发生率虽低于对照组,但无统计学差异(9.09%vs 12.73%,P=0.540)。结论 IVUS能有效指导左主干病变PCI支架定位,辅助判断支架扩张和贴壁情况。

Objective To study the value of intravascular ultrasonography for PCI in patients with complicated left main coronary artery lesions.Methods One hundred and ten patients with complicated left main coronary artery lesions who underwent PCI in our hospital were divided into control group(n=55)and observation group(n=55).Their basline data,MLD,MLA and area of stenosis(AS),implanted stent parameters(such as the diameter,length and release pressure of stent,pressure and diameter of expansion balloon)were compared.The patients were followed up for 1 year,during which the blood flow and MACE at the two target lesions were recorded.Results The MLD,diameter and length of implanted stents,diameter of expansion balloon were significantly longer,the MLA was significantly larger,the pressure of expansion balloon was significantly higher while the AS was significantly smaller and the total incidence of MACE was significantly lower in observation group than in control group(2.17±0.36 vs 1.62±0.59,P=0.000;4.94±1.61 vs 2.51±1.77,P=0.000;3.54±0.24 vs 3.34±0.31,P=0.002;14.41±5.25 vs 12.11±4.21,P=0.038;3.98±0.51 vs 3.77±0.38,P=0.040;17.04±2.89 vs 14.47±2.49,P=0.000;63.23±8.17 vs 77.31±7.42,P=0.000;9.09%vs 12.73%,P=0.540).Conclusion Intravascular ultrasonography can effectively guide the stenting position,judge the expansion of stent and whether the stent is tightly placed against the coronary artery wall in patients with complicated left main coronary artery lesions undergoing PCI.