血管内低频高能超声对冠状动脉粥样斑块消融的临床应用

Feasibility of disruption of atherosclerotic plaques using catheter-delivered high-intensity and low-frequency ultrasound

目的 观察血管内低频高能量超声对冠状动脉粥样斑块的消融作用及安全性。方法 应用Rayfiled公司ACOLYSISSYSTEMTM 超声溶栓仪 (4 6kHz,18W/cm2 ) ,通过导管技术对 18例冠状动脉有一支血管狭窄≥ 75 %的冠心病患者进行消融 ,测量消融前后血管的狭窄程度变化 ,观察消融中有无冠状动脉痉挛、撕裂等影像学改变 ,检测手术前后CK MB、心电图ST段及运动试验的改变。结果 18例患者消融前病变血管狭窄程度为 (84 6 9± 4 6 9) % ,术后残余狭窄为 (4 0 11± 15 33) % ,较术前降低 4 4 5 8% (P <0 0 5 )。 7例术后残余狭窄 <30 % ,术前压低的ST段消融术后均明显上移 ,其中 4例压低的ST段消融术后完全恢复正常 ;术后运动诱发心绞痛所需时间、运动诱发ST段下降 0 1mV所需时间、运动诱发ST段下降最大幅度与手术前比较差异均有显著性 ,而消融与超声消融 +PTCA运动试验差异无显著性 ,7例消融后残余狭窄 <30 %的患者 6个月后冠状动脉造影显示血管狭窄与术后即刻比较差异无显著性。消融术中无血管夹层、破裂、急性血管闭塞、血栓形成及血管痉挛并发症。结论 低频高能超声消融术明显有效地裂解粥样硬化斑块 ,降低斑块所致冠状动脉的狭窄程度 ,是恢复冠状动脉血流的有效手段。

Objective To evaluate the clinical feasibility of disruption of intracoronary plaques using catheter-delivered ultrasound. Methods Ultrasound was introduced via catheterization to treat patients (n=18) with serious stenosis of the coronary artery. Comparison of stenosis degree and ST segment in routine ECG before and after the treatment was conducted. Pre- and post-treatment exercise tests were performed to measure the time needed for induction of angina, the time needed for induction of decrease in ST segment for 0.1 mV and maximal range of decrease in ST segment. Results Ultrasound was found to have dissolved atherosclerotic plaques in 18 cases of coronary heart disease with stenosis in one blood vessel ≥75%. The residual stenosis was (40.11±15.33)% after the treatment, representing a decrease of 44.58% as compared with that before the treatment [(84.69±4.69)%], P<0.05. In 7 out of these 18 patients, the residual stenosis was less than 30%. ST segment in ECG was markedly lifted up after the treatment in all patients. There were remarkable differences between the time needed for exercise-induced angina, the time for exercise-induced decrease in ST segment for 0.1 mV and the maximal range of decrease in ST segment before and after the treatment. Conclusion Angioplasty with high-intensity and low-frequency ultrasound can be used as a new approach to treating serious stenosis and improving blood flow of the coronary artery.