血管内超声对高压扩张冠状动脉支架置入的指导作用High-pressure intracoronary stent implantation under intracoronary ultrasound guidance
佟子川,崔亮,王乐丰,王红石,邹阳春,葛永贵,倪祝华,徐立,李惟铭,杨新春
摘要(Abstract)：
目的 观察支架高压扩张后的血管内超声 (IVUS)结果 ,并用其指导支架置入 ,探讨IVUS在高压扩张时代的应用价值。方法 对 84处病变进行支架置入 ,当达到冠状动脉 (冠脉 )造影理想的支架置入标准时 ,应用IVUS进行评价 ,符合IVUS理想的支架置入标准的病变归入不需进一步干预组 (NAI组 ) ,不符合IVUS理想的支架置入标准的病变归入需进一步干预组 (AI组 )。在IVUS指导下对AI组进行进一步干预 ,直到符合IVUS理想标准或最大压力达到 2 0 2 6 5kPa。比较AI组在首次扩张后和最终的IVUS结果以及最终两组之间的结果。结果 在首次高压扩张后 ,有 4 9(5 8 3% )处病变 (NAI组 )的IVUS结果符合理想的支架置入标准 ,35 (4 1 7% )处病变 (AI组 )的IVUS结果未达到理想的支架置入标准从而进行了更高压力的进一步扩张。AI组经过更高压力扩张后 ,最终有 2 9(82 9% )处病变达到理想的支架置入标准。支架内最小横截面积由 (7 3± 2 0 )mm2 增加至 (9 3±2 0 )mm2 (P <0 0 0 1) ,急性获益由 (71± 15 ) %增加至 (91± 15 ) % (P <0 0 0 1)。结论 即使采用了高压扩张 (12 15 9～ 14 18 6kPa)技术 ,也不能确保达到满意的支架扩张。对于高压扩张后造影结果满意但IVUS结果不理想的病变 ,在IVUS指导下的更高压力 (16 2 1 2?
关键词(KeyWords)： 超声检查,介入性;支架;冠状动脉疾病
基金项目(Foundation):
作者(Author): 佟子川,崔亮,王乐丰,王红石,邹阳春,葛永贵,倪祝华,徐立,李惟铭,杨新春
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