压力导丝腔内侧压评估粥样硬化性肾血管病

Pressure Wire Study in Atherosclerotic Renovascuar Disease for Clinical Diagnosis

目的:评价压力导丝应用于肾动脉内压力测定的可行性和安全性;评估经压力导丝测定的压力阶差以及计算的生理学参数与选择性肾动脉造影的相关性。材料和方法:共入选19例患者,其中男15(78.9％)例,年龄49～78岁,平均(62.0±8.5)。入选病例均行选择性肾动脉造影,测定肾动脉主干直径狭窄(％)程度,对于直径狭窄≥30％的肾动脉主干病变,行压力导丝(Pressure Wire,Radi Medical Systems,瑞典)检查。结果:共25处病变接受压力导丝检查,无并发症。开口病变13处,其余12处为肾动脉主干病变,病变平均长度(12.8±6.1)mm。入选病变狭窄程度为33％～89％,平均(65.5±14.9)％。Pearson相关性检验分析,直径狭窄程度与压力导丝测定的压力参数及其推算的生理学指标之间的相关性较好。收缩压阶差与平均动脉压阶差之间,硝酸甘油扩张血管前、后的压力阶差之间,以及血流储备分数(FFR)与压力阶差之间,都显示较好的相关性。根据三次多项式回归方程,直径狭窄50％、60％和70％对应的收缩压阶差分别为14.09mmHg、26.00mmHg和46.40mmHg,平均压阶差分别为2.68mmHg、4.98mmHg和8.91mmHg,以及FFR分别为0.96、0.90和0.81。结论:压力导丝应用于肾动脉腔内压力测定,操作简便、安全无并发症、结果可靠。经压力导丝测定的跨病变压力阶差与选择性?

Objective: To observe the clinical safety and feasibility of the pressure measurement of intra - renal artery with a miniaturized pressure guide wire and to determine the hemodynamic significance of arteriographically detected renal arterial stenosis by obtaining pressure gradients with the pressure wire. Materials and Methods: Bilateral selective renal arteriography was performed in 19 patients [(15 men, 78.9%; age range, 49 ~ 78; mean age (62.0+ 8.5)] with atherosclerotic renal-artery stenosis. When a renal arterial stenosis defined as a decrease in luminal diameter of 30% or more identified, the intra - arterial systemic pressure was measured continuously with a transducer and the miniaturized pressure gradient wire system (Pressure Wire; Radi Medical Systems, Sweden) . Results: All procedures were well tolerated, and no complications were observed in any of the 19 patients. Thirteen lesions were ostial, and the other 12 stenoses were located in main renal arteries. The stenoses ranged in severity from 33% to 89% ; the mean severity was (65.5+14.9)%. The systolic and mean arterial pressure gradients with and those without vasodilatation were highly correlated with diameter stenosis severity. We used regression analyses to elucidate the relationships further, and the curvilinear third - order exponential fit showed better correlation. According to the regression equation, at 50% , 60% , and 70% diameter stenosis severity, the systolic pressure gradient was 4.09mmHg, 26.00 mmHg, and 46.40mmHg; the mean pressure gradient was 2.68mmHg, 4.98 mmHg, and 8.91mmHg; and FFR was 0.96, 0.90, andO.81, respectively. Conclusions: We believe that the pressure wire provides a reliable and useful functional measurement. The pressure measurements in the main renal artery correlate well with diameter stenosis severity.