血管内超声辅助腔内治疗肾动脉狭窄

Intravascular ultrasound assisted endovascular therapy for renal artery stenosis

目的观察血管内超声(IVUS)辅助腔内治疗肾动脉狭窄(RAS)的价值。方法回顾性分析30例接受腔内治疗的RAS患者,比较治疗前CT血管造影(CTA)及IVUS所测狭窄段肾动脉管腔及斑块参数,采用Bland-Altman图评估CTA与IVUS评估管腔截面积狭窄率及斑块偏心指数的一致性;记录植入球囊扩张覆膜支架后即刻IVUS所测支架相关参数。结果治疗前IVUS所测最小管腔直径、管腔截面积狭窄率及狭窄段长度均大于,而最大管腔直径及管腔偏心指数均小于CTA测值(P均<0.05);IVUS与CTA所测斑块偏心指数、斑块类型及狭窄远端重构差异均无统计学意义(P均>0.05)。IVUS与CTA评估管腔截面积狭窄率及斑块偏心指数的平均差值分别为-0.020(-0.096,0.050)及-0.020(-0.130,0.091),二者评估斑块偏心指数的一致性优于管腔截面积狭窄率。支架植入后即刻IVUS所测支架对称性、支架偏心指数、支架扩张系数及狭窄覆盖率分别为(82.69±14.61)%、(1.54±9.16)%、(99.81±10.70)%及100%。30例中,2例(2/30,6.67%)因IVUS显示支架近端贴壁欠佳而接受后扩张。结论IVUS可辅助评估狭窄段肾动脉管腔及斑块参数、指导释放支架并实时监测腔内治疗RAS效果。

Objective To observe the value of intravascular ultrasound(IVUS)for assisting endovascular therapy for renal artery stenosis(RAS).Methods Thirty patients with RAS who underwent endovascular therapy were retrospectively analyzed.Parameters of renal artery and plaques in RAS segment measured with CT angiography(CTA)and IVUS before treatment were compared.Bland-Altman diagram was performed to evaluate the consistency of lumen cross-sectional stenosis rate and plaque eccentricity index between CTA and IVUS.The stent parameters measured with IVUS were recorded immediately after implantation of balloon-expandable covered stents.Results Before treatment,the minimum lumen diameter,lumen cross-sectional stenosis rate and stenotic segment length of IVUS were all larger,while maximum lumen diameter and lumen eccentricity index of IVUS were both smaller than those of CTA(all P<0.05).No significant difference of plaque eccentricity index,plaque type nor stenosis distal remodeling was found between CTA and IVUS(all P>0.05).The average difference between IVUS and CTA for evaluating lumen cross-sectional stenosis rate and plaque eccentricity index was-0.020(-0.096,0.050)and-0.020(-0.130,0.091),respectively.The consistency of IVUS and CTA for evaluating plaque eccentricity index was better than that of lumen cross-sectional stenosis rate.The stent symmetry,stent eccentricity index,stent expansion coefficient and stenosis coverage rate immediately after implantation measured with IVUS was(82.69±14.61)%,(1.54±9.16)%,(99.81±10.70)%and 100%,respectively.Among 30 cases,2 cases(2/30,6.67%)underwent postdilation since poor stent apposition.Conclusion IVUS could assist evaluating lumen and plaque parameters of stenotic renal arteries,guiding stent release and real-timely monitoring the effect of endovascular therapy.