经皮冠状动脉介入时应用多普勒超声检测冠状动脉微栓塞

Objective: To validate an intracoronary Doppler ultrasound device for high intensity transient signals(HITS) detection and to assess the incidence of HITS during percutaneous coronary intervention(PCI). Methods and Results: In an in vitro model, particle count and number of HITS detected by an intracoronary 0.014 inch Doppler wire were closely correlated(r=0.97, p< 0.001). In the clinical study, 32 patients(mean(SD) age 61(11) years; 23 men, nine women) with coronary artery disease were treated with balloon dilatation and stent implantation for a single vessel stenosis. In these patients HITS were detected during PCI in 84%(27 of 32). Reproducibility(r=0.99, p< 0.001) and interobserver agreement(r=0.84, p< 0.001)of HITS counts were significant. The number of HITS after stent implantation was significantly higher than after balloon dilatation(11(7) v 2(4), p< 0.001). Postprocedural coronary flow velocity reserve(CFVR) was< 2.0 in 55%(16 of 29) of all patients after balloon dilatation and< 2.0 in 23%(six of 26) after stent implantation. The number of HITS after stent implantation did not differ significantly between patients with CFVR< 2.0 and patients with CFVR ≥2.0(12(8) v 10(7), not significant). Conclusions: Embolic particles can be detected as HITS by an intracoronary Doppler ultrasound device. Coronary microembolism is often observed during PCI, especially after stent implantation. However, the incidence of HITS alone does not explain a reduced CFVR after PCI.

利用多普勒超声检测接受择期经皮冠状动脉介入治疗的稳定性心绞痛患者中的冠状动脉微栓塞

背景：经皮冠状动脉介入（PCI）时，冠状动脉内多普勒导丝可实时检测并定量微栓塞。本研究旨在探讨行择期PCI时，多普勒检出微栓塞的频率是否与肌坏死发生率相关。方法和结果：研究对象为52例连续的冠状动脉疾病患者（年龄64土10岁，男性36例，女性16例），这些患者均因单支血管狭窄行择期PCI。利用冠状动脉内多普勒超声比较了22例围手术期非ST段抬高型心肌梗死（pNSTEMI）患者和30例无pNSTEMI患者在PCI过程中微栓塞的检出率。这两组患者在临床和操作特征方面均具有可比性。