血管内超声在冠心病左主干病变介入诊疗中的指导价值研究  

Value of intravascular ultrasound guidance in the assessment of percutaneous intervention treatment for patients with left main coronary artery disease

作　　者：刘华云[1] 鄢华[1] 刘道权[1] 宋丹[1] 彭剑[1] 郭进[1] 张龙岩 夏成雨[1] 苏晞[1] 

机构地区：[1]武汉亚洲心脏病医院心内科,430022

出　　处：《中国心血管杂志》2016年第4期288-291,共4页Chinese Journal of Cardiovascular Medicine

基　　金：武汉市卫生局临床医学科研项目(WX12C41);湖北省卫生厅青年科技人才项目(QJX2012-35)~~

摘　　要：目的应用血管内超声(IVUS)进行指导,分析冠状动脉造影(CAG)在冠状动脉左主干病变介入诊治时的局限和不足,为左主干病变的诊断和经皮冠状动脉介入治疗(PCI)提供有价值的信息。方法入组冠心病左主干病变患者60例,分为左主干口部及体部组和左主干远段分又组,每组各30例。联合应用IVUS和CAG评估病变、指导介入治疗及评估支架置入效果等,分析两组间的差异。结果两组中GAG测量的左主干平均参考直径、最小管腔直径及最小管腔面积均小于IVUS测量结果,差异均有统计学意义(均为P<0.05)。左主干口部及体部病变组中8例(26.7%)CAG判断结果与IVUS差异明显;CAG与IVUS指导下左主干远段分叉的支架策略差异较大,不相符者达30%。两组中IVUS指导的支架置入后扩张的比例均明显高于CAG指导下的比例(P<0.05)。结论与IVUS相比,CAG不能精确诊断冠心病左主干病变,指导左主干病变PCI治疗的准确性也有限,建议冠心病左主干病变患者的介入诊治应常规联合应用IVUS进行指导。Objective To explore the value of application of intravascular ultrasound （ IVUS） guidance and analyze the limitations of coronary angiography in the assessment and to provide valuable information for percutaneous coronary intervention （PCI） treatment of left main （LM） lesion. Methods The 60 patients with LM lesion were enrolled in this study. The patients were divided into two groups：ostium and trunk lesion of LM group and distal or bifurcation lesion of LM group, 30 cases in each group. Combined coronary angiography （ CAG ） and IVUS was used to assess the lesion, guide the PCI treatment and evaluate the immediate effect of PCI after stent implantation. Differences of two groups were compared. Results The mean reference diameter,the minimum lumen diameter and the minimum lumen area of LM lesion measured by coronary angiography were significantly smaller than that by IVUS （ all P〈0. 05 ） . In 8 cases （ 26. 7%） of the ostium and trunk of LM lesion group, the measurement parameters of were significantly different between those CAG and IVUS results. CAG and IVUS guidance for distal left main bifurcation stent policy show larger differences, those who do not match were up to 30%. The proportion of post-dilation was significantly higher in IVUS guided group than in angiography guided group （P〈0. 05）. Conclusions Compared with IVUS, CAG cannot accurately diagnose coronary artery disease with left main disease, treatment with PCI CAG guidance accuracy is also limited. We recommend the routine application of IVUS in the PCI treatment of LM lesion.

关 键 词：左主干 血管成形术 经腔 经皮冠状动脉 冠状动脉造影 超声检查 介入性 

分 类 号：R541.4[医药卫生—心血管疾病]