血管内超声的临床应用进展

Progress of clinical application of intravascular ultrasound

血管内超声可以清晰地观察冠状动脉(冠脉)的三维结构,在冠脉介入诊疗中发挥了很大的作用,比如能精准指导慢性完全闭塞病变、左主干病变、分叉病变及临界病变的支架植入、支架后扩张、寻找支架植入失败的原因;并且可以预防对比剂肾病,特别是合并肾功能不全的急性冠脉综合征患者,能减少围术期的肾损害,可明显改善患者的预后。此外,血管内超声可行零对比剂的介入治疗,预防对比剂过敏。但是在不同的临床情况中如何规范地使用血管内超声,目前国际上缺乏相应的指南,现总结近期的研究成果,阐述血管内超声在以上几种复杂病变、预防碘对比剂肾病和碘对比过敏患者中的使用情况,希望能对基层医院的冠脉介入治疗有一定的指导意义。

Intravascular ultrasound can clearly observe the three-dimensional structure of coronary arteries,and plays a great role in coronary interventional diagnosis and treatment.For example,it can accurately guide the stent implantation of chronic complete occlusion lesions,left main artery lesions,bifurcation lesions and critical lesions,stent dilatation,and find the cause of failure of stent implantation.Moreover,it can prevent contrast-agent nephropathy,especially in patients with acute coronary syndrome complicated with renal insufficiency,reduce perioperative renal damage and significantly improve the prognosis of patients.In addition,intravascular ultrasound can be used for interventional treatment of zero contrast agent,which can prevent contrast agent allergy.However,there is a lack of relevant international guidelines on how to use intravascular ultrasound in different clinical situations in a standardized manner.This paper summarizes the recent research results and expounds the use of intravascular ultrasound in the patients with the above complex lesions,the prevention of iodine contrast agent nephropathy and iodine contrast allergy.It is hoped that it can guide the coronary intervention in primary hospitals.