血管内超声在冠状动脉临界病变治疗中的指导作用  

Role of intravascular ultrasound in determining the treatment strategy for intermediate coronary stenosis

作　　者：章晓国[1] 陈继远[1] 汤成春[1] 丁建东[1] 沈成兴[1] 戴启明[1] 陈忠[1] 罗丹[1] 童嘉毅[1] 王润民[1] 王慧萍[1] 冯毅[1] 马根山[1] 

机构地区：[1]东南大学附属中大医院心内科,江苏南京210009

出　　处：《现代医学》2009年第4期284-287,共4页Modern Medical Journal

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。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 stenosis 〉 70%, 16 patients with percent area stenosis 〈 70%, but with typical clinical symptom, and 15 patients who had ruptured plaque or had coronary dissection. Transient coronary spasm was found in only 4 patients during the procedure of IVUS, and disappeared shortly after coronary infusion of nitroglycerin. There was no ischemic cardiac events occurred in all patients over the 6 months of follow up. Conclusions A precise characterisation of the composition of atherosclerotic plaques and measurement of stenosis can be made in patients with angiographic evidence of nonsignificant coronary lesions with the use of IVUS. This accurate and reproducible imaging modality can be used safely in determining the therapeutic strategy for the patients with intermediate coronary stenosis.

关 键 词：血管内超声 临界病变 冠状动脉造影术 

分 类 号：R541.4[医药卫生—心血管疾病]