[经典]血管内超声在冠状动脉临界病变治疗中的指导作用

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1、［经典］血管内超声在冠状动脉临界病变治疗中的指导作用血管内超声在冠状动脉临界病变治疗中的指导作用［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)%o对IVUS

2、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。❷［关键词］血管内超声;临界病变;冠状动脉造影术❷［中图分类号］R541.4［文献标识码］A［文章编号］1671-7562(2009)04-0284-04Roleofintravascula

3、rultrasoundindeterminingthetreatmentstrategyfor❷intermediatecoronarystenosisZHANGXiao-guo,CHENJi-yuan,TANGCheng-chun,DINGJian-dong,SHENCheng-xing,DAIQi-ming,❷CHENZhong,LUODan,TONGJia-yi,WANGRen-min,WANGHui-ping,FENGYi,MAGen-shan(DepartmentofCardiology,Zhongd

4、aHospital,SoutheastUniversity,Nanjing210009,China)Abstract:ObjectiveToevaluatetheroleofintravascularultrasound(IVUS)indeterminingthetreatmentstrategyforintermediatecoronarystenosis・MethodsIVUSwasperformedin150patienlswhohadlesionsofintermediateseverity(40%~7

5、0%diameterstenosis)incoronaryangiography(CAG)・Thecharacteristicsoftheatheroscleroticplaqueswereanalyzedandseverityofstenosiswasevaluated.ResultsInall150patients,therewere98(65.3%)whohadsoftplaqueinthelesion.Therewere85(56.7%)whohadeccentricplaqueand❷46(30.7%

6、)concentricplaqueinthelesions.Normalfindingwasmadein4patients・Theaverageofpercentareastenosiswas(59.4±10.7)%inthelesion.Percutaneouscoronaryinterventionwasperformedin62patientswhohadlesionswithpercentareastenosis>70%,16patientswithpercenlareastenosis<70%,but

7、withtypicalclinicalsymptom,and15patientswhohadrupturedplaqueorhadcoronarydissection.Transientcoronaryspasmwasfoundinonly4patientsduringtheprocedureofIVUS,anddisappearedshortlyaftercoronaryinfusionofnitroglycerin.Therewasnoischemiccardiaceventsoccurredinallpa

8、tientsoverthe6monthsoffollowup.ConclusionsAprecisecharacterisationofthecompositionofatheroscleroticplaquesandmeasurementofstenosiscanbemadeinpatientswithangiographicevidenceofnonsignificantcoron