【摘要】 目的:了解血管内超声(IVUS)在急性心肌梗死(AMI)急诊支架置入中的应用价值以及安全性。方法:对74处梗死相关病变进行支架置入,当达到冠状动脉造影(CAG)理想的支架置入标准时,应用IVUS进行评价,达到IVUS理想支架置入标准的病变归人组1,未达到IVUS理想支架置入标准的病变归入组2。在IVUS指导下对组2进行进一步干预,直到达到IVUS理想的支架置入标准或最大扩张压力达到2026.5kPa。比较组2在首次扩张和最终的IVUS结果以及两组之间的最终结果。结果:在首次高压扩张后,有44(59.5%)处病变(组1)的IVUS结果符合理想的支架置入标准,30 (40.50%)处病变(组2)的IVUS结果未达到理想的支架置入标准从而进行了更高压力的进一步扩张。组2在经过更高压力扩张后,最终有26(86.7%)处病变达到理想的IVUS支架置人标准。支架内最小横截面积由首次扩张后的(6.9±1.4) mm2增加至最终的(9.1±1.6)mm2(P<0.001),急性获益由首次扩张后的(71.0±15.4)%增加至最终的(98.3±16.2)% (P<0.001)。结论:IVUS应用于指导急诊AMI的支架置入安全有效,能够增加支架内最小横截面积,改善支架小梁的贴壁程度和对称程度。对于高压扩张(1215.9～1418.6 k Pa)后造影结果满意但IVUS结果不理想的病变,在IVUS指导下的更高压力(1621.2-2026.5kPa)扩张使86.7%的病变进一步改善了扩张结果。更多还原

【Abstract】 Objective: To understand appliance value and security of intracoronary ultrasound (IVUS) performed in stent deployrnent in patients with acute myocardial infarction (AMI) . Methods: From December 2002 to February 2004, 74 patients with AMI were selected to be examined by emergency coronary angiography and stents were deployed in 74 infarction related lesions. IVUS were performed in all cases to evaluate stent apposition, symmetry, and lumen dimension after optimal angiography results were reached. If inadequate IVUS result was found, further dilations with higher - pressure or larger balloon and subsequent stent reevaluation with IVUS were performed until optimal criteria were met or dilation pressure reached 2026.5 kPa. Results: Optimal criteria of IVUS were obtained in 44(59.5% ) lesions (Groupl) after initial high - pressure dilatation and intrastent additional higher - pressure dilatation was performed in 30 (40.5%) lesions (Group2) whose ultrasound results did not reach the criteria. In patients requiring additional inflations, minimum stent area increased from(6.9±1.4)mm2 to (9. 1±1.6)mm2 (P < 0.001) acute gain (ISMLCSA/AvgRLCSA) increased from (71.0±15.4) % to (98.3±16.2)% (P<0.001) . At last, optimal criteria of IVUS were obtained in 26 (86.7%) lesions in Group2. Conclusion: Stent deployment guided by IVUS is feasible and safe in selected patients with AMI. It can improve minimum stent area, stent strut sticking on vessel wall and augment acute lumen gain. IVUS applied in stent implantation in patients with AMI can improve intervention therapy effect.更多还原