杨菲菲,王禹,陈练,荆晶,王立军,张威,张国明,张慧,张大为,白启才

• 1:中国人民解放军总医院第一附属医院心血管内科

摘要(Abstract)：

目的评价血管内超声(IVUS)对无保护左主干(ULMCA)病变药物支架介入治疗的指导作用及对于预后的影响。方法 2003年4月—2008年6月150例无保护LMCA病变患者接受介入治疗,年龄(62.5±10.82)岁(38～83岁),其中44例(29.33%)患者术中应用血管内超声指导。结果 IVUS对斑块性质的分析显示非分叉病变组软斑块多见,而分叉病变组混合斑块(纤维钙化)多见;单纯冠脉造影组与IVUS组测得数据比较,前者的最小管腔直径(1.72±0.62)mm比(2.27±0.38)mm,最小管腔面积(2.62±1.87)mm2比(4.93±1.63)mm2,均明显低于IVUS组,面积狭窄率(78.08±7.31%)比(64.53±9.18)%,明显高于IVUS组,且单纯冠脉造影组置入的支架比IVUS指导组偏小(3.46±0.36)mm比(3.75±0.26)mm;IVUS指导组的再发心绞痛(15.91%比35.8%)、TLR(0%比16.05%),和总MACE事件(2.27%比19.75%)均明显低于无IVUS指导组。结论无保护左主干病变介入治疗术中应用IVUS指导可显著改善预后,减少MACE事件的发生。

关键词(KeyWords)： 无保护左主干病变;药物洗脱支架;超声检查,介入性

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 杨菲菲,王禹,陈练,荆晶,王立军,张威,张国明,张慧,张大为,白启才

参考文献(References)：

• [1]Valgimigli M,vanMieghem CA,Ong AT,et al.Short-and longterm clinical out-come after drug-eluting stent implantation for the percutaneous treatment of left main coronary artery disease:in-sights from the Rapamycin-Eluting and Taxus Stent Evaluated At Rotterdam Cardiology Hosp ital registries(RESEARCH and T-SEARCH).Circulation,2005,111:1383-1389.
• [2]Mintz GS,Nissen SE,Anderson WD,et al.American College of Cardiology Clinical Expert Consensus Document on Standards for Acquisition,Measurement and Reporting of Intravascular Ultra-sound Studies(IVUS).Areport of the American College of Car-diology Task Force on Clinical Expert Consensus Documents.J Am Coll Cardiol2001,37:1478-1492.
• [3]Fisher LD,Judins MP,Lesperance J,et al.Reproducibility of cornary arteriographic reading in the Cornary Artery Surgery Study(CASS).Cathet Cardiovasc Diagn,1982,8:565-575.
• [4]Hermiller JB,Bller CE,Tenaglia AN,et al.Unrecognized left main coronary artery disease in patient undergoing interventional procedures.Am J Cardiol,1993,71:173-176.
• [5]Hu FB,Tamai H,Kosuga K,et al.Intravascular ultrasouncl-guided directional coronary atherectomy for unprotected Ieft main coronary stenosis with distal bifurcation involvement.Am J Cardi-ol,2003,92:936-940.
• [6]Jasti V,Ivan E,Yalamanchili V,et al.Correlations between frac-tional flowreserve and intravascular ultrasound in patients with an ambiguous left main coronary artery stenosis.Circulation,2004,110:2831-2836.
• [7]Park SJ,Hong MK,Lee CW,et al.Elective stenting of unpro-tected left main coronary artery stenosis.J Am Coll Cardiol,2001,38:1054-1060.
• [8]Fassa A,Wagatsuma K,Higano S,et al.Intravascular uhrasound-guided treatment for angiographicaIly indeterminate left main cor-onary artery disease.A long-term follow-up study.J Am Coll Car-diol,2005,45:204-211.
• [9]Russo R,Wong SC,Marchant D,et al.Intravascular ultrasounddi-rected clinical decision-making in the setting of an inconclusive left main coronary angiogram:final results fromthe left main IVUS registry.Circulation,2003,108Suppl IV:462.
• [10]Fischell TA,Carter AJ.Unprotected left main stenting:an alter-native to CABG in a DES world J Invasive Cardiol,2005,17:129-130.