血管内超声在冠状动脉慢性闭塞病变支架植入术中的应用

Application of intravascular ultrasound in coronary stent implantation for the chronic total occlusive coronary artery disease

目的 :评价血管内超声(intravascular ultrasound,IVUS)指导下的慢性完全闭塞(chronic total occlusion,CTO)病变介入治疗的临床疗效。方法 :自2017年1月至2019年1月,282例在我院成功行介入治疗的冠状动脉CTO病变的患者为研究对象,除外急性ST段抬高的急性心肌梗死、冠状动脉左主干病变及2支以上慢性血管闭塞的患者,按倾向匹配得分法(propensity matching score,PSM)1∶2匹配入选54例患者在IVUS指导下行支架植入术(IVUS组),108例患者在单纯冠状动脉造影(coronary arteriography,CAG)指导下行支架植入术(CAG组),全部患者均详细记录其临床和生化指标。详细记录2组患者的临床特征、住院期间和1年随访期间的主要不良心血管事件(major adverse cardiovascular events,MACE)(包括死亡、心绞痛复发及因缺血所致的再次血运重建等)。结果:2组患者在年龄、性别构成、吸烟、高血压、糖尿病、高血脂、卒中、陈旧性心肌梗死、既往经皮冠状动脉介入术(percutaneous coronary intervention,PCI)史、外周血管疾病史的人数、J-CTO评分、对比剂用量和X线透视时间差异无统计学意义。2组患者在植入支架个数差异无统计学意义[(2.28±0.76)个比(2.40±077)个,P=0.349],但与CAG组相比,IVUS组植入支架平均直径明显大[(3.02±0.32) mm比(2.94±0.26) mm,P=0.031],植入支架总长度明显短[(59.28±22.56) mm比(68.43±24.74) mm,P=0.002],支架内再狭窄率和MACE的发生率明显降低(5.6%比18.5%,P=0.047)。结论:IVUS指导下的CTO病变支架植入术是安全、有效的,可明显减少支架内再狭窄,改善此类患者的临床预后。

Objective To evaluate the clinical efficacy of intravascular ultrasound(IVUS)-guided interventional therapy for the chronic total occlusion(CTO) lesions. Methods From January 2017 to January 2019, 282 patients with the CTO coronary artery disease who undergone interventional treatment in our hospital were enrolled, excluding the patients with acute ST-segment elevation in acute myocardial infarction, coronary artery left main disease and 2 or more CTO lesions.The patients were selected according to propensity matching score(PSM), 1∶2 matching. Fifty-four patients were selected to undergo IVUS-guided stent implantation and classified into the IVUS group. One hundred and eight patients undergone coronary angiography(CAG) guided stent implantation were classified into the CAG group. The clinical and biochemical indicators in all patients were recorded in detail. The clinical characteristics of patients in the two groups, the major adverse cardiovascular events(MACE)(including death, recurrence of angina pectoris, and revascularization due to ischemia)during hospitalization and one-year follow-up were recorded in detail. Results There were no significant differences between the two groups in age, gender, smoking, hypertension, diabetes, hyperlipidemia, stroke, old myocardial infarction,previous history of percutaneous coronary intervention(PCI), and history of peripheral vascular disease. There were also no significant differences in J-CTO score, dose of contrast, fluoroscopy time and the number of stent implants between the two groups(2.28±0.76 vs 2.40±077, P=0.349), but compared with the CAG group, the average diameter of the implanted stent in the IVUS group [(3.02±0.32) mm vs(2.94±0.26) mm, P=0.031] was significantly larger, the total length of the implanted stent [(59.28±22.56) mm vs(68.43±24.74) mm, P=0.002] was significantly shorter, and the rate of in-stent restenosis and MACE(5.6% vs 18.5%, P=0.047) was significantly lower. Conclusions IVUS-guided stent implantation for CTO lesions is safe and effective. It can significantly reduce the rate of in-stent restenosis and improve the clinical prognosis of the patients.