冠状动脉内超声对冠心病介入疗效的评价研究(摘要)

中国循环杂志 1999年第0期第14卷 摘要　冠心病介入治疗

作者：施海明　朱　军　罗心平　王受益　范维琥　王彩萍

单位：上海市，上海医科大学附属华山医院　心内科(200040)

　　目的：应用冠状动脉内超声(ICUS)显像，并与冠状动脉造影(CAG)对比，评价冠心病患者经皮冠状动脉腔内成形术(PTCA)及冠状动脉内支架置入术的介入疗效，探讨其在临床实践中的应用价值。

　　方法：14例患者(男10例、女4例，年龄54～77岁，平均68±6岁)在施行冠状动脉介入性诊断和治疗前和(或)后进行了ICUS检查。其中稳定性心绞痛7例，不稳定性心绞痛5例，胸痛原因待查2例。有10例进行了PTCA术，8例置入了支架。共检查靶血管14支，包括左前降支9支，回旋支1支，右冠状动脉4支。

　　结果：①6例PTCA术后即刻ICUS检查发现5例存在血管夹层和斑块破裂，占83.3%,这5处夹层部位均为钙化或混合斑块。其中2例可见小内膜撕裂片在管腔内随血流飘动，而CAG仅发现1例(16.7%)有明显夹层(P=0.038)。②7例支架置入后CAG均示结果满意，但ICUS发现符合最佳支架置入标准者仅2例(28.6%),P=0.013,另5例靶病变为钙化、混合斑块者，支架膨展差、贴壁不佳或存在游离腔隙。4例在支架边缘处存在内膜撕裂，其中2例在术后3个月和6个月分别发生支架及支架近端再狭窄。③左冠状动脉系统中10支左主干血管，虽然CAG均示正常，但超声发现有7例(70%)存在粥样斑块或明显内膜增厚(P=0.0016)。④在19例次的超声成像过程中，1例发生一过性血管痉挛，冠状动脉内给硝酸甘油后缓解。

　　结论：ICUS能够准确判断PTCA术后血管夹层，对支架成功置入有重要指导价值，并可揭示隐匿的左主干病变。因此，在临床上可作为一种与CAG互为补充的诊断工具。

Assessment of Coronary Interventional Results by Using Intracoronary Ultrasound(Abstract)

Department of cardiology, Huashan Hospital, Shanghai Medical University, Shanghai (200040)

　　shi Haiming, Zhu Jun, Luo Xinping, et al.

　　objective: The purpose of the present study was to evaluate the coronary artery response to percutaneous transluminal coronary angioplasty (PTCA) or/and intracoronary stenting by using intracoronary ultrasound (ICUS).

　　Methods: iCUS imaging was performed in 14 patients (4 women and 12 men, mean age 68±6 years) before or/and after coronary intervention procedures, ten of them underwent PTCA, eight intracoronary stenting. Target vessels imaged by ICUS inclued nine in LAD, one LCX and four RCA.

　　Results:① Six patients underwent ICUS imaging after PTCA immediately. In five cases (83.3%), we observed the presence of dissection or plaque fracture at the site of angioplasty, and two of them with small intimal flaps into the lumen. The plaque composition of these target lesions was calcified or mixed plaque. However, only one of them (16.7%) had been diagnosed angiographically (p=0.038). ② seven patients performed ICUS imaging after intraconorary stenting. Coronary angiograms revealed satisfactory results in all cases with stenting, but only two of them achieved the ICUS criteria for optimal stent deployment, five cases appeared incomplete stent apposition or inadequate stent expansion (p=0.013), four cases were found vessel intimal tearing at the edge of stents, two of them occurred restenosis at the margin of the stent or in-stent at three months and six months after stenting, respectively. ③ Additionally, ten left main coronary arteries had an normal angiographic appearance, but 70% of them present crescent-shaped eccentric plaque or markedly intimal thickening(p=0.001 6). ④ Complications: only one case had transient vessel spasm during the procedure, but reverted after catheter pullback and intracoronary nitroglycerin.

　　Conclusion:① ICUS can assess the coronary angioplasty results accurately and has an important role in guiding the optimal stent placement; ② ICUS may provide information about plaque composition and reveal occult left main coronary artery disease.