血管内超声引导双吻挤压支架治疗复杂冠状动脉分叉病变的应用  

Comparison of intravascular ultrasound-guided and angiographic-guided double kiss crish stenting in the treatment of complex coronary artery bifurcation disease

作　　者：张鹏朝 梅益斌[1] 陈金笑 李邹鸿 ZHANG Pengzhao;MEI Yibin;CHEN Jinxiao;LI Zouhong(Department of Interventional Radiology,Lishui People's Hospital,Zhejiang 323000,China)

机构地区：[1]丽水市人民医院介入科,浙江丽水323000

出　　处：《影像诊断与介入放射学》2024年第5期361-366,共6页Diagnostic Imaging & Interventional Radiology

摘　　要：目的比较血管内超声(IVUS)与冠脉造影(CAG)引导双吻挤压支架治疗复杂冠状动脉分叉病变的效果。方法回顾性分析2020年6月—2023年7月接受IVUS引导行双吻挤压支架治疗并完成随访的47例复杂冠状动脉分叉病变(IVUS组)和行CAG引导双吻挤压支架治疗并完成随访的42例复杂冠状动脉分叉病变(CAG组),共计89例患者临床资料。比较两组基线资料、冠状动脉主支和分支介入术(PCI)成功率、手术时间、住院时间、单次治疗费用、支架个数、支架长度、支架直径;观察两组术前(T0)、术后即刻(T1)、术后6个月(T2)的主支、分支病变最小管径(MLD)、狭窄程度及术后1年的主要不良心血管事件(MACE)发生率。结果IVUS组的分支血管PCI成功率(97.87%)高于CAG组(85.71%),支架直径[(3.53±0.50)mm]长于CAG组[(2.95±0.22)mm],差异有统计学意义(χ2=4.524、t=6.901,P<0.05)。IVUS组T2时点的主支、分支病变MLD[(2.87±0.54)mm、(2.31±0.24)mm]分别高于CAG组[(2.64±0.45)mm、(2.12±0.19)mm],而主支、分支狭窄程度[(8.90±0.64)%、(8.09±1.33)%]则低于CAG组[(9.27±0.98)%、(8.96±1.88)%],差异有统计学意义(P<0.05);两组主支血管PCI成功率、手术时间、住院时间、单次治疗费用、支架个数、支架长度和T0、T1时点的主支、分支病变MLD、狭窄程度比较,差异无统计学意义(P均>0.05)。IVUS组术后1年的主支和分支靶血管再狭窄、再发心绞痛、靶血管心肌梗死、靶血管血运重建等发生率高于CAG组,但差异无统计学意义(P>0.05)。结论IVUS引导下双吻挤压支架治疗复杂冠状动脉分叉病变,与CAG引导相比,有助于选择更合理的支架,提高PCI成功率和降低主要不良心血管事件发生率。Objective To compare the effect of intravascular ultrasound(IVUS)-and coronary angiography(CAG)-guided double kissing crush stenting in the treatment of patients with complex coronary artery bifurcation disease.Methods Retrospective analysis was performed on 89 patients with complex coronary bifurcation disease in our hospital from June 2020 to July 2023.The patients were treated with IVUS-guided(47,IVUS group)or CAG-guided(42,CAG group)double-kiss crush stents.The baseline data,percutaneous coronary intervention(PCI)success rate of main and branch vessels,procedure time,hospital stay,total hospitalization cost,number of stents,stent length and stent diameter were compared.The degree of minimal lumen diameter(MLD),stenosis of major and branch lesions before,immediately after,and 6 months after the procedure,and the incidence of major adverse cardiovascular events(MACE)at 1 year were also compared.Results The success rate of branch vessel PCI(97.87%)was significantly(χ2=4.524,t=6.901,P<0.05)higher and the stent diameter[(3.53±0.50)mm]was longer in the IVUS group than that in the CAG group[85.71%,(2.95±0.22)mm].The MLD of the main[(2.87±0.54)mm]and branch[(2.31±0.24)mm]lesions at 6 months after treatment in the IVUS group were higher than those in the CAG group[(2.64±0.45)mm,(2.12±0.19)mm].The degrees of stenosis of the main[(8.90±0.64)%]and branch[(8.09±1.33)%]vessels in the IVUS group were significantly(P<0.05)lower than those of CAG group[(9.27±0.98)%,(8.96±1.88)%].There was no significant difference between the two groups(all P>0.05)in the success rates of main vessel PCI,procedure time,hospital stay,total hospitalization cost,number of stents,length of stents,MLD and stenosis of main and branch lesions before and immediately after the procedure.The incidences of main and branch vessel restenosis,recurrent angina pectoris,target vessel myocardial infarction and target vessel revascularization in IVUS group were not significantly higher than that in the CAG group one year after treatment(P>0.05).Concl

关 键 词：血管内超声 冠脉造影 双吻挤压支架 复杂 冠状动脉分叉病变 

分 类 号：R445.1[医药卫生—影像医学与核医学] R816.2[医药卫生—诊断学] R541[医药卫生—临床医学]