放射影像及实时血管内超声指导下零造影剂冠状动脉介入治疗临床应用分析

Clinical application analysis of zero contrast agent coronary intervention under the guidance of radiography and real-time intravascular ultrasound

目的探讨"零造影剂"经皮冠状动脉介入治疗(PCI)在有造影剂过敏史患者中应用及随访情况。方法选取北部战区总医院自2017年5月至2019年4月收治的12例具备PCI临床适应征且因预先行冠状动脉血管造影或冠状动脉CT出现造影剂中、重度过敏患者为研究对象。在实时血管内超声(IVUS)指引下进行零造影剂PCI手术。观察患者手术即刻成功率、临床成功率及主要不良心血管事件(MACE)发生情况。结果12例患者均成功置入支架,且术中未使用任何造影剂。所有患者均未发生手术相关并发症,手术即刻成功率为100%(12/12),临床成功率为100%(12/12)。所有患者平均随访时间(9.9±1.8)个月,无MACE发生,且未见造影剂过敏事件发生。结论对于需要血运重建的造影剂过敏患者,无需造影剂,使用放射影像及IVUS可安全指导PCI,具有较高的即刻成功率和临床成功率,且无相关并发症发生。

Objective To investigate the application and follow-up of"zero contrast agent"percutaneous coronary intervention(PCI)in patients with a history of contrast allergy.Methods A retrospective study was performed on 12 cases of patients with moderate or severe contrast agent allergy due to coronary angiography or coronary CT who were admitted from May 2017 to April 2019.Zero contrast agent PCI was performed under the guidance of real-time intravascular ultrasound(IVUS).The immediate success rate,clinical success rate and major adverse cardiovascular events were observed.Results Stent placement was successful in all 12 patients and no contrast agent was used.All the patients had no surgical complications,and the immediate success rate was 100%(12/12)and the clinical success rate was 100%(12/12).The mean follow-up time of all patients was(9.9±1.8)months.There was no MACE and no contrast agent allergy.Conclusion For patients with contrast hypersensitivity requiring revascularization,no contrast agent is needed,PCI can be safely guided by IVUS and radiography,with high immediate and clinical success rates,and no related complications.