球囊后扩张同时推注对比剂评估支架贴壁的血管内超声评价

The Intravascular ultrasound evaluation of balloon post-dilatation simultaneous injection contrast evaluating stent adherence

目的采用血管内超声(Intravascular ultrasound,IVUS)评价球囊后扩张同时推注对比剂(Balloon Post⁃dilatation simulta⁃neous injection contrast,BPIC)用以判断经皮冠状动脉介入治疗(PCI)时支架的贴壁状态。方法选取2018年1月1日至2018年10月10日,徐州医科大学附属医院行经皮冠状动脉介入治疗术(Percutaneous coronary intervention,PCI)的原位病变冠心病病人30例。根据定量冠脉造影(Quantitative coronary angiography,QCA)结果指导支架、球囊的选择,在PCI术中于支架释放后由远及近采用多次BPIC方法判断支架贴壁,然后行IVUS检查评价支架释放后的贴壁情况;以BPIC时球囊远端无前向对比剂且无分支显影时为支架贴壁良好的指标。结果30例病例,共计植入54枚支架,经过BPIC,支架最大直径大于支架型号而与后扩球囊型号相当[(3.54±0.66)比(3.21±0.55)mm,P<0.05;(3.54±0.66)比(3.59±0.75)mm,P>0.05],支架对称指数为0.86±0.05;QCA与IVUS对支架最大直径的测量存在显著线性相关(r=0.997,P=0.000);50枚支架经BPIC与IVUS均判断为贴壁良好,BPIC与IVUS判断支架贴壁差异无统计学意义(χ2=2.25,P>0.05)。结论BPIC方法判断支架贴壁可靠性高,支架扩张充分,在PCI术中采用该方法可以评估支架贴壁。

Objective Using Intravascular ultrasound(IVUS)to evaluate the reliability of balloon post⁃dilatation simultaneous in⁃jection contrast(BPIC)judging the stent attachment in percutaneous coronary intervention.Methods From January 1,2018 to Oc⁃tober 10,2018,30 patients with coronary heart disease in situ underwent percutaneous coronary intervention(PCI)in the Affiliated Hospital of Xuzhou Medical University.The results of quantitative coronary angiography(QCA)were used to guide the choice of stent and balloon.In PCI,multiple BPIC were used from far and near to judge the stent attachment after stent release and then the IVUS was used to evaluate the adherence of the stent.When the BPIC was used,no forward contrast agent at the distal end of the balloon and no branch development was used as a good indicator of stent adherence.Results In 30 cases,a total of 54 stents were implanted.After BPIC,the maximum diameter of the stent was larger than that of the stent model and was equivalent to that of the posterior balloon[(3.54±0.66)vs.(3.21±0.55)mm,P<0.05;(3.54±0.66)vs.(3.59±0.75)mm,P>0.05],the stent symmetry index was 0.86±0.05;there was a significant linear correlation between QCA and IVUS for measuring the maximum diameter of the stent(r=0.997,P=0.000);50 stents were judged by BPIC and IVUS as good adherence,there was no statistical difference between BPIC and IVUS in judging stent adherence(χ2=2.25,P>0.05).Conclusion The reliability of judging stent attachment by BPIC is high and the stent is fully expanded.This method can be used to evaluate stent adherence during PCI.