血管内超声在冠状动脉临界病变治疗中指导作用.docVIP

血管内超声在冠状动脉临界病变治疗中指导作用[摘要] 目的 探讨血管内超声(IVUS)对冠状动脉造影(CAG)临界病变治疗的指导意义。方法 对经选择性CAG提示冠状动脉临界病变的150例150处病变进行IVUS检查,分析动脉粥样硬化斑块类型、性质及其狭窄程度。结果 150处病变中,软斑块98例(65.3%),硬斑块33例(22.0%);偏心斑块85例(56.7%),向心斑块46例(30.7%);4例检测结果正常。斑块面积平均狭窄率为(59.4±10.7)%。对IVUS示斑块面积狭窄大于70%的62例、小于70%的16例但有典型临床症状者,以及15例有斑块破裂或夹层者行进一步介入治疗。4例患者在IVUS检查过程中出现冠状动脉痉挛现象,经处理后不良反应立即消失。所有患者随访6个月以上,未出现严重心脏缺血事件。结论 IVUS能进一步明确冠状动脉临界病变的性质和狭窄程度并能指导临床治疗,安全性高。? [关键词] 血管内超声;临界病变;冠状动脉造影术? [中图分类号] R541.4 [文献标识码] A [文章编号] 1671-7562(2009)04-0284-04 Role of intravascular ultrasound in determining the treatment strategy for ?intermediate coronary stenosis ZHANG Xiao-guo,CHEN Ji-yuan,TANG Cheng-chun,DING Jian-dong,SHEN Cheng-xing,DAI Qi-ming,?CHEN Zhong,LUO Dan,TONG Jia-yi,WANG Ren-min,WANG Hui-ping, FENG Yi,MA Gen-shan (Department of Cardiology,Zhongda Hospital,Southeast University,Nanjing 210009,China) Abstract:Objective To evaluate the role of intravascular ultrasound(IVUS) in determining the treatment strategy for intermediate coronary stenosis.Methods IVUS was performed in 150 patients who had lesions of intermediate severity(40%～70% diameter stenosis) in coronary angiography(CAG).The characteristics of the atherosclerotic plaques were analyzed and severity of stenosis was evaluated.Results In all 150 patients,there were 98(65.3%) who had soft plaque in the lesion.There were 85(56.7%) who had eccentric plaque and ?46(30.7%) concentric plaque in the lesions.Normal finding was made in 4 patients.The average of percent area stenosis was (59.4±10.7)% in the lesion.Percutaneous coronary intervention was performed in 62 patients who had lesions with percent area stenosis70%, 16 patients with percent area stenosis 0.5为向心斑块。(2)斑块性质。将动脉粥样斑块分为软斑块(脂质斑块)、硬斑块(纤维斑块、钙化斑块和混合斑块)。斑块主要成分的回声低于血管外膜回声者为软斑块,接近或者等同于血管外膜回声者为纤维斑块,钙化病变的特点为强回声伴后方声影,若斑块成分有多种回声则视为混合斑块。(3)斑块破裂。指斑块内膜的纤维帽破裂,完整性被破坏。(4)定量分析。包括测定动脉粥样硬化斑块处外弹力膜横截面积、管腔横截面积、斑块面积、斑块负荷(斑块面积/外弹力膜横截面积×100%),即面积狭窄程度。(5)冠状动脉重构。用重构指数(remodeling index,RI)表示。RI=(靶病变处外弹力膜横截面积/近远端参考血管外弹