血管内超声分析左主干分叉病变主支植入支架后分支血管受累的原因  

Mechanism of lumen loss of the left circumflex ostium after main vessel stent implantation: observations by intravascular ultrasound

作　　者：修建成[1] 廖伟明[1] 刘博[1] 张新渌[1] 侯玉清[1] 黄铮[1] 郭志刚[1] 周忠江[1] 曹世平[1] 崔凯[1] 

机构地区：[1]南方医科大学南方医院心内科,广东广州510515

出　　处：《南方医科大学学报》2013年第7期1045-1048,共4页Journal of Southern Medical University

基　　金：广东省自然科学基金(S2012010009024)

摘　　要：目的探讨左主干分叉病变主支植入支架后分支血管受累的机制。方法 28例采用Provisional T策略的LMCA病变,用血管内超声(Intravascular Ultrasound,IVUS)观察主支置入支架前后及对吻扩张后LMCA远端及分支管腔大小和斑块分布变化。结果 LCX开口部管腔减小由主支支架前的5.9±2 mm2减小到4.9±1.9 mm2,P<0.01;LCX开口部斑块CSA由5.4±2.9 mm2增加到5.7±2.9 mm2,P=0.21;LCX开口管腔的CSA变化与LCX开口EEM的CSA变化呈正相关,LCX开口管腔CSA变化与斑块CSA变化无关。球囊对吻前后相比,LCX管腔CSA由4.9±1.9 mm2增大到5.5±1.9 mm2,P<0.01,LCX开口部斑块CSA无明显变化(5.7±2.9 mm2vs 5.7±2.6 mm2,P=0.89),LCX开口管腔CSA变化与LCX开口EEM的CSA变化呈正相关,(R=0.432,P=0.02)。结论 LMCA分叉病变主支植入支架后,大多数LCX开口受累的主要原因是血管嵴部移位,部分病例存在LMCA远端斑块向LCX开口移位;球囊对吻扩张可以改善carina移位,但是不能改善斑块移位。Objective To explore the mechanism of lumen loss of the left circumflex ostium after main vessel stent implantation. Methods Twenty- eight patients undergoing provisional T technique were enrolled in this study. Intravascular ultrasound （IVUS） examination was performed before and after main vessel stenting and kissing balloon post- dilatation to evaluate the geometrical changes of the vessels. Results The CSA of LCX ostium lumen decreased significantly from 5.9±2 mm 2 to 4.9±1.9 mm 2 （P〈0.01） after the procedure, and the CSA of LCX ostium PM increased from 5.4±2.9 mm 2 to 5.7±2.9 mm 2 （P=0.21） after the main vessel stenting. The changes in LCX ostium lumen CSA was correlated with the changes of LCX ostium EEM CSA but not the LCX ostium PM CSA. After kissing balloon post- dilatation, the CSA of LCX ostium lumen increased from 4.9 ± 1.9 mm2 to 5.5±1.9 mm 2 （P〈0.01） , and the CSA of LCX ostium P M showed no obvious changes （5.7±2.9 mm 2 vs 5.7±2.6 mm 2 , P= 0.89）. The changes of LCX ostium lumen CSA were correlated with the those of the LCX ostium EEM CSA （R=0.432, P=0.02）. Conclusion After stent implantation from the LMCA to the LAD, most of lumen losses of the LCX are due to carina shift, and in occasional cases, plaque shift occurs from the distal LMCA to the ostium of the LCX. Kissing balloon technique can adjust carina shift but can not improve plaque shift.

关 键 词：左主干 分叉 支架 嵴部 移位 血管内超声 

分 类 号：R543[医药卫生—心血管疾病]