应用血管内超声指导冠状动脉临界病变介入治疗

Intravascular ultrasound guided interventional therapy for borderline coronary lesions in patients

摘要:

目的 探讨应用血管内超声(IVUS)检查与定量冠状动脉造影(QCA)方法在冠状动脉临界病变介入治疗中的应用价值。方法 选择经冠状动脉造影(CAG)检查显示冠状动脉狭窄程度在40％～70％的临界病变患者60例,根据检查方法不同将患者分为QCA组和IVUS组,分别应用QCA和IVUS测量两组病变血管的参考管腔直径、最小管腔直径、直径狭窄率、管腔面积狭窄率及最小管腔面积并进行比较。比较观察两组患者住院期间、随访1月、6月和12月的主要不良心血管事件(再发心绞痛、心肌梗死、靶病变再次冠状动脉成形术、死亡)的发生情况。结果 IVUS组冠状动脉的管腔直径狭窄率[(57.80％±8.18％)比(51.73％±7.91％)]及面积狭窄率[(67.01％±10.41％)比(57.07％±10.71％)]均高于QCA组(P＜0.05),而最小管腔面积[(3.90±0.79) mm²比(4.14±0.60) mm²]则低于QCA组(P＜0.05)。住院期间两组患者均无主要不良心血管事件发生,但自随访第1月开始至12月随访结束,IVUS组的主要不良心血管事件发生率显著低于QCA组(7.7％比26.7％,P＜0.05)。结论 IVUS检查与QCA相比对冠状动脉临界病变检测出的狭窄率更显著,并能更有效地发现“不稳定性”病变并指导冠状动脉临界病变支架的植入,减低心血管事件发生,改善预后。

关键词:临界病变;血管内超声;定量冠状动脉造影;经皮冠状动脉介入治疗

Abstract:

Aim To explore the value of intravascular ultrasound (IVUS) and quantitative coronary angiography (QCA) in the interventional therapy of borderline coronary lesions. Methods 60 patients with borderline coronary lesions(coronary artery stenosis between 40％～70％ confirmed by coronary angiography (CAG)) were enrolled. They were divided into QCA group(n=30, received QCA examination after CAG) and IVUS group (n=30, received IVUS detection after CAG). QCA and IVUS quantitative analysis were used to measure difference in reference vessel diameter, minimal lumen diameter, minimal lumen area, stenotic rates of diameter and area between two groups, and qualitative analysis was used to detect coronary plaques imaging morphology with IVUS. Finally, all the patients were followed up for 12 months. Incidence rate of major adverse cardiovascular events (MACE) during admission and follow-up were compared between two groups. Results Compared with QCA group, the ratio of lumen diameter stenosis ((57.80％±8.18％) vs (51.73%±7.91%)) and area stenosis ((67.01％±10.41％) vs (57.07%±10.71%)) were increased, while the ratio of minimum lumen area ((3.90±0.79) mm² vs (4.14±0.60) mm²) was decreased in IVUS group (P＜0.05). Meanwhile there was no MACE during admission in two groups, but the incidence rate of MACE was significantly lower in IVUS group than that in QCA group since one month after follow-up started(P＜0.05). Conclusion Compared with QCA, IVUS can detect more severe stenosis rate of angiographical borderline lesions, more effectively detect “unstable” lesions, guide percutaneous coronary intervention of borderline lesion, reduce the occurrence of cardiovascular events, and improve the prognosis.

Key words:borderline lesion; intravascular ultrasound; quantitative coronary angiography; PCI