血管内超声在分叉病变诊疗中的应用研究

Study on the application of intravascular ultrasound in diagnosing bifurcation lesions

目的应用IVUS评价分析分叉病变介入诊疗中的局限和不足,为分叉病变术式的选择及术后效果情况提供有价值的依据。方法选择2015年12月—2017年6月在本院住院的冠心病分叉病变患者40例,将患者随机分为IVUS+CAG评估病变组和仅CAG评估组,每组各20例。分析两组间的术式选择差异、后扩张比例及1年内心肌梗死发生率。结果在IVUS+CAG指导下的分叉病变术式选择为单支架(65%)双支架(35%),仅CAG评估组的分叉病变术式选择为单支架(55%)双支架(45%); IVUS指导下的支架后扩张比例明显高于仅CAG指导下的比例(P<0.05)。IVUS指导下的PCI术后患者1年内MACE发生率明显低于CAG组(P<0.05)。结论单纯CAG指导分叉病变的诊疗存在局限性,联合IVUS可大大提高分叉病变诊疗的精准度。

Objective To analyze the limitation and deficiency of interventional diagnosis and treatment of bifurcation lesions by IVUS,and to provide a valuable basis for the selection of surgical methods and the postoperative effect of bifurcation lesions. Methods Forty patients with coronary artery disease bifurcation were randomly divided into two groups: IVUS plus CAG group and CAG group,20 cases in each group. The choice of operation,the ratio of post-dilation and the incidence of myocardial infarction within 1 year were analyzed between the two groups.Results Under the guidance of IVUS plus CAG,the procedure of bifurcation lesions was selected as 65% of single stent and 35% of double stent,and in the CAG evaluation group,choice were 55% of single stent and 45% of double stent.The rate of post stent dilatation under the guidance of IVUS was significantly higher than that under the guidance of CAG( P< 0.05). The incidence of MACE in patients with PCI under the guidance of IVUS was significantly lower than that in the group of CAG.Conclusions Single CAG guides the diagnosis and treatment of bifurcation lesions still has its limitations,and the combination of IVUS could greatly improve the accuracy of diagnosis and treatment of bifurcation lesions.