【摘要】 目的探讨血管内超声(IVUS)指导药物洗脱支架置入的价值。方法对38例急性冠状动脉综合征患者67处病变行IVUS检查,指导药物洗脱支架置入。置入后再行IVUS,对未达到理想释放者进行高压球囊后扩张。观察6个月主要不良心脏事件。结果首次常规高压扩张置入支架,67处病变均达到冠状动脉造影理想标准,但符合IVUS理想标准仅40处(59.7%),27处(40.3%)未达标;行高压球囊后扩张,又有21处达到IVUS理想标准。最终达到IVUS理想标准者与常规高压扩张后比较,差异有统计学意义(91.0%对59.7%,P<0.0001)。随访期间无一例心源性死亡或再梗死,再发心绞痛2例(5.3%)。结论常规高压球囊扩张置入药物洗脱支架,并不能使所有支架达到IVUS理想标准。IVUS指导下高压球囊后扩张可进一步改善药物洗脱支架置入效果,具有重要临床价值。更多还原

【Abstract】 Objective To investigate the significance of intravascular ultrasound (IVUS) in drug-eluting stent implantation in patients with acute coronary syndrome (ACS).Methods IVUS was applied to evaluate 67 lesions of 63 coronary arteries in 38 patients and drug-eluting stent deployment.If IVUS criteria of optimal stent deployment were not met,post-dilatation with noncompliant balloons at higher pressure and reassessment with IVUS were performed.Major adverse cardiac events (cardiac death,reinfarction,recurrent angina and revascularization) during follow-up of six months were observed.Results Optimal angiographic criteria were achieved in all lesions after stenting with conventional high-pressure dilatation,but optimal criteria of IVUS were only obtained in forty lesions ( 59.7% ).Twenty-seven lesions ( 40.3% ) failed to achieve optimal criteria of IVUS and were treated with post-dilatation with 16 to 20 atm,then twenty-one lesions obtained the optimal criteria of IVUS.The frequency of achieving optimal criteria of IVUS increased from 59.7% to 91.0% (P< 0.0001 ).There were two patients of recurrent angina(5.3%),and no death and reinfarction were observed during follow-up.Conclusions All drug-eluting stent deployment under moderately high-pressure inflation could not achieve optimal criteria of IVUS.And post-dilatation with IVUS guidance could improve effects of intervention.Stenting with IVUS guidance is safe and effective.更多还原