【摘要】 目的　观察冠脉内超声 (IVUS)指导下进行直接冠脉内支架置入术的可行性及临床效果。方法　 12例冠心病患者常规冠脉造影术后 ,对拟行直接支架置入术的血管行IVUS术 ,观察病变特性 ,记录病变处血管壁直径 ,病变狭窄处最小腔径及病变长度。根据IVUS测得的病变血管壁直径及病变长度选择置入支架。支架置入后再行IVUS检查 ,观察支架贴壁性 ,两端有无夹层 ,测量管腔内支架最小径 /最大径比值 ,决定是否进一步处理。近期随访有无急性或亚急性血栓形成和主要心脏事件 (心脏性死亡、与靶血管相关的心绞痛、心肌梗死及再次血管重建 )。结果　经IVUS指导下 ,12例冠心病患者直接支架置入术全部成功。冠脉造影显示无残余狭窄 ,TIMI血流 3级。 2例患者支架置入后IVUS检查贴壁不满意 ,管腔最小径 /最大径比值 <0 7,经进一步高压扩张达标。最终IVUS显示全部支架贴壁及展开满意 ,管腔最小径 /最大径比值≥ 0 7,病变处最小径由术前平均 1 2± 0 87mm增至术后 3 4± 2 8mm。 1～ 4个月随访无血栓形成及主要心脏事件。结论　IVUS指导下直接冠脉内支架置入术成功率高 ,并发症少 ,临床应用安全有效更多还原

【Abstract】 Objective The purpose of this study was to determine the feasibility and efficiency of direct stent implantation with intravascular ultrasound (IVUS) guidance Methods 12 native vessel target lesions in 12 patients were studied by coronary angiography and direct stent implantation Ultrasound imagines obtained at the treatment site before and after stenting were analyzed quantitatively for in lesion vessel wall diameter, in lesion minimal lumen diameter and in lesion vessel length Direct stent deployment was performed with IVUS guidance The ends of follow up were acute or subacute thrombosis and major cardiac events (MCE: cardiogenic death, angina pectoris, myocardial infarction and revascularization correspondence with target vessel) Results Direct stenting was successfully performed in 12 patients with IVUS guidance Coronary angiography showed that there was no residual stenosis and TIMI 3 flow was obtained in all patients Further balloon dilation of the stent was performed by observation of the IVUS imagines in two patients The final IVUS imagines showed that ratio of minimal lumen diameter/maximum lumen diameter ≥0 7 and in lesion minimal lumen diameter increased from 1 2±0 87 mm to 3 4±2 8 mm No thrombosis and MCE were found in all patients in 1 4 months follow up Conclusion Direct stenting with IVUS guidance in selected patients had higher success rates, less complications and better clinical results更多还原