摘要
目的用血管内超声(IVUS)与冠状动脉造影(CAG)对照研究冠状动脉分叉病变主支支架跨越分支技术(Cross-over技术)对直径≥2mm的分支的影响,分析分支狭窄加重和急性闭塞的机制以及斑块和血管的形态学对分支转归的影响。方法对32例患者的35处分叉病变全部进行介入治疗前后IVUS检查,对比分析术后IVUS和量化冠状动脉造影(QCA)下分支受影响情况,利用IVUS目测术后分叉处斑块移位,多因素分析术前分叉处主支和分支开口的病变形态学特征对分支转归的影响。结果术前IVUS和QCA测得的分支开口直径狭窄率(D%)为18.67%±16.29%和29.06%±23.15%(P<0.05),面积狭窄率(A%)为31.17%±25.54%和42.22%±31.81%(P>0.05);术后IVUS和QCA测得的分支急性闭塞率均为2.86%,原有狭窄加重发生率分别为14.29%和48.57%(P=0.012),新出现狭窄发生率分别为11.43%和14.29%(P=0.294);IVUS测定术前、术后分支开口的管腔横截面积(L-CSA)分别为5.780±3.677 mm2和6.143±3.545 mm2,t=0.405,P=0.687。而QCA测得的D%和A%较术前明显加重(术前比术后,D%为29.06%±23.15%比42.24%±20.38%,t=2.482,P=0.016;A%为42.22%±31.81%比60.22%±27.33%,t=2.492,P=0.015)。IVUS分析分支开口狭窄加重的原因包括斑块移入、血管壁皱缩,其他可能的原因包括血管痉挛和血管变形(椭圆形趋势)。术前分叉处主支软斑块与术后分支狭窄有关。结论与IVUS相比,QCA高估冠状动脉分叉病变分支开口的狭窄程度。冠状动脉分叉病变Cross-over技术后,CAG高估分支受影响的程度;造成分支开口狭窄加重的可能原因包括斑块移入、血管壁皱缩、痉挛和血管变形。术前分叉处主支软斑块是预测分支狭窄受影响的因素。
Objective To analyze the effect on side branch with diameter ≥2.0 mm after stenting with cross-over technique in non-left main coronary bifurcation by using IVUS and QCA. Methods Comparative analysis was made on the IVUS and QCA results of the side branches in 35 non-left main bifurcation lesions which were intervened by cross-over technique. Results The diameter and area stenosis rates of the side branches examined by IVUS compared with QCA before intervention were 18.67% ± 16. 29% vs 29. 06% ± 23.16% and 31.17% ± 25.54% vs 42. 22% ± 31.81% respectively. After crossover interventional therapy, acute occlusion of the side branches detected by both IVUS and QCA was 2. 86%. The rates of aggravated stenosis and newly developed stenosis in the side branches shown by IVUS and QCA were 14. 29% vs 48.57% （P =0. 012） and 11.43% vs 14. 29% （P =0. 294）. Post-intervention morphology of the side branches detected by IVUS included plaque shift, vessel wall shrink, spasm and deformation. By using logistic analyzing, existence of soft plaque in the main branches was an independant factor affecting the fate of the side branches. Conclusion Comparing with IVUS results, QCA may overestimate the degree of stenosis of the side branches after cross-over technique. The possible mechanism of side branch complications shown by IVUS included plaque shift, vessel wall shrink, spasm and deformation. Soft plaque in the main branch is an independant influencing factor of the result in the side branches.
出处
《中国介入心脏病学杂志》
2008年第3期145-149,共5页
Chinese Journal of Interventional Cardiology
关键词
冠状动脉疾病
冠状血管
支架
超声检查
介入性
Coronary disease
Coronary vessels
Stents
Uhrasonography, interventional
