冠状动脉内超声指导冠状动脉内支架置入

摘要

Objective　To observe the immediate angiographic and intravascular ultrasound (IVUS) results and their effects on one month clinical outcomes in forty-one patients who submitted to coronary stent deployment with IVUS guidance. rnMethods　All patients were allocated to coronary stent implantation with high inflation pressure. After good angiographic results (<20% residual stenosis), all patients underwent IVUS and higher-pressure dilatation would be necessary if criteria for optimal coronary stent implantation were not met. The optimal criterion of IVUS for stent implantation was the ratio of intrastent lumen cross-sectional area to the average of the proximal and distal reference lumen cross-sectional areas ≥80%. All patients had aspirin and ticlopidine therapy on the day of angioplasty and during the one month follow-up period. rnResults　Optimal criteria of IVUS were obtained without any further intrastent dilatation in twenty-five patients but intrastent higher-pressure dilatation was performed in fourteen patients whose ultrasound results did not reach the criteria. In these patients, we increased the minimal intrastent lumen area 25.7% (P<0.05). Thirty-five patients (90%) had good minimal intrastent lumen area of IVUS. There were no deaths, myocardial infarction, acute stent thrombosis or need for revascularization during the study and the one month follow-up. rnConclusions　Intracoronary stent deployment under IVUS guidance, including combining aspirin and ticlopidine therapy, had beneficial ultrasound results and good clinical outcomes after one month follow-up.%目的　对41例冠心病患者病变冠状动脉(冠脉)在血管内超声(IVUS)指导下置入支架，并评价造影和IVUS及一个月临床结果。rn方法　本文采用支架置入IVUS标准： 支架内截面积≥近端和远端相关血管腔截面积平均值的80%，结合抗血小板药以防支架内亚急性血栓形成。rn结果　支架置入后25例达到标准， 不需再扩张; 14例IVUS不满意者(造影结果良好)过扩张支架，支架内截面积增加25.7%(P<0.05); 2例因超声导管未跨过支架无超声资料。最终35例(90%)得到满意IVUS(支架内最小截面积8.5±2.2mm2)， 结合阿司匹林和噻氯匹定治疗，无一例死亡、心肌梗死和支架内血栓形成。rn结论　IVUS是一指导冠脉支架置入安全有效手段。