中华心血管病杂志
中華心血管病雜誌
중화심혈관병잡지
Chinese Journal of Cardiology
2008年
11期
980-984
,共5页
侯静波%孟令波%景慎鸿%韩志刚%于淮%于波
侯靜波%孟令波%景慎鴻%韓誌剛%于淮%于波
후정파%맹령파%경신홍%한지강%우회%우파
冠状动脉疾病%超声检查,介入性%支架%体层摄影术,光学相干
冠狀動脈疾病%超聲檢查,介入性%支架%體層攝影術,光學相榦
관상동맥질병%초성검사,개입성%지가%체층섭영술,광학상간
Coronary disease%Ultrasonoraphyk,interventional%Stent%Tomography,optical coherence
目的 应用光学相干断层成像(OCT)及血管内超声(IVUS)检测技术评价冠状动脉内粥样硬化斑块的稳定性,并指导支架置入,检测血管对置入支架后即刻和中远期的反应.方法 选择2008年2-7月间的27例患者,进行冠状动脉造影、OCT及IVUS检查,共检查了30支血管,其中8处为药物支架植入术后血管,并对19处病变进行了支架置入.结果 除外支架置入的8例(置入6个月～4年)外,其余22例病变行OCT及IVUS检查,发现稳定性斑块5例,不稳定斑块17例,其中OCT检出内膜小撕裂4例(IVUS未检出,P＞0.05),冠状动脉撕裂伴夹层病变5例(IVUS检出1例,P＞0.05),血栓形成5例(IVUS检出1例,P＞0.05),偏心斑块伴薄纤维帽12例(IVUS检出2例,P＜0.01).8例曾经进行支架治疗的患者,造影、OCT和IVUS发现2例再狭窄;OCT显示支架内膜覆盖良好,IVUS小能精确看到内膜;OCT检测出1例患者有支架后瘤样扩张.对17例不稳定性斑块及2例支架再狭窄病例行支架置入术,术后支架膨胀不良发生率26.0%,OCT及IVUS检出率相同;支架贴壁不良发生率63.2%,IVUS榆出率低于OCT(10.5%比63.2%,P＜0.01);支架近远端撕裂10.5%,IVUS均不能检出;内膜脱垂发生率52.6%,IVUS检出率低于OCT(10.5%比52.6%,P＜0.05).结论 OCT与IVUS相比,在不稳定性斑块检测准确度方面明显优于IVUS,更能精确指导冠状动脉支架置人.IVUS在操作简便性及反映斑块负荷方面要优于OCT.
目的 應用光學相榦斷層成像(OCT)及血管內超聲(IVUS)檢測技術評價冠狀動脈內粥樣硬化斑塊的穩定性,併指導支架置入,檢測血管對置入支架後即刻和中遠期的反應.方法 選擇2008年2-7月間的27例患者,進行冠狀動脈造影、OCT及IVUS檢查,共檢查瞭30支血管,其中8處為藥物支架植入術後血管,併對19處病變進行瞭支架置入.結果 除外支架置入的8例(置入6箇月～4年)外,其餘22例病變行OCT及IVUS檢查,髮現穩定性斑塊5例,不穩定斑塊17例,其中OCT檢齣內膜小撕裂4例(IVUS未檢齣,P＞0.05),冠狀動脈撕裂伴夾層病變5例(IVUS檢齣1例,P＞0.05),血栓形成5例(IVUS檢齣1例,P＞0.05),偏心斑塊伴薄纖維帽12例(IVUS檢齣2例,P＜0.01).8例曾經進行支架治療的患者,造影、OCT和IVUS髮現2例再狹窄;OCT顯示支架內膜覆蓋良好,IVUS小能精確看到內膜;OCT檢測齣1例患者有支架後瘤樣擴張.對17例不穩定性斑塊及2例支架再狹窄病例行支架置入術,術後支架膨脹不良髮生率26.0%,OCT及IVUS檢齣率相同;支架貼壁不良髮生率63.2%,IVUS榆齣率低于OCT(10.5%比63.2%,P＜0.01);支架近遠耑撕裂10.5%,IVUS均不能檢齣;內膜脫垂髮生率52.6%,IVUS檢齣率低于OCT(10.5%比52.6%,P＜0.05).結論 OCT與IVUS相比,在不穩定性斑塊檢測準確度方麵明顯優于IVUS,更能精確指導冠狀動脈支架置人.IVUS在操作簡便性及反映斑塊負荷方麵要優于OCT.
목적 응용광학상간단층성상(OCT)급혈관내초성(IVUS)검측기술평개관상동맥내죽양경화반괴적은정성,병지도지가치입,검측혈관대치입지가후즉각화중원기적반응.방법 선택2008년2-7월간적27례환자,진행관상동맥조영、OCT급IVUS검사,공검사료30지혈관,기중8처위약물지가식입술후혈관,병대19처병변진행료지가치입.결과 제외지가치입적8례(치입6개월～4년)외,기여22례병변행OCT급IVUS검사,발현은정성반괴5례,불은정반괴17례,기중OCT검출내막소시렬4례(IVUS미검출,P＞0.05),관상동맥시렬반협층병변5례(IVUS검출1례,P＞0.05),혈전형성5례(IVUS검출1례,P＞0.05),편심반괴반박섬유모12례(IVUS검출2례,P＜0.01).8례증경진행지가치료적환자,조영、OCT화IVUS발현2례재협착;OCT현시지가내막복개량호,IVUS소능정학간도내막;OCT검측출1례환자유지가후류양확장.대17례불은정성반괴급2례지가재협착병례행지가치입술,술후지가팽창불량발생솔26.0%,OCT급IVUS검출솔상동;지가첩벽불량발생솔63.2%,IVUS유출솔저우OCT(10.5%비63.2%,P＜0.01);지가근원단시렬10.5%,IVUS균불능검출;내막탈수발생솔52.6%,IVUS검출솔저우OCT(10.5%비52.6%,P＜0.05).결론 OCT여IVUS상비,재불은정성반괴검측준학도방면명현우우IVUS,경능정학지도관상동맥지가치인.IVUS재조작간편성급반영반괴부하방면요우우OCT.
Objective To evaluate the value of combined optical coherence tomography (OCT) and intravascular ultrasound (IVUS) examinations in detecting coronary artery plaque during percutaneous transluminal coronary intervention (PCI).Methods CICT and IVUS examinations were performed on 30 diseased coronary vessels from 27 patients underwent PCI from Feb.2008 to Jul.2008.Results Seventeen vulnerable plaques (4 intima tearing which were not detected by IVUS),5 plaque rupture (1 out of 5 was detected by IVUS),5 thrombus lesions (1 out of 5 was found by IVUS),12 thin-cap lipid-rich lesions (2 detected by ivus) were detected by OCT in 22 lesions (without 8 lesions post DES stents).Analysis result of plaque burden by IVUS was superior to that obtained by OC T.In 8 DES stents (implanted for 6 months to 4 years).OCT detected 2 had severe restenosis,6 stents struts were completely covered with neointima without restenosis,1 stent had aneurysm-like dilatation.IVUS results were similar except for limitations on exactly detecting neointima post stenting.In 19 newly implanted stents.the incidence of stent underexpansion detected by OCT was 26.0% (same as that by IVUS).stent malappesition was 63.2% (10.5%by IVUS,P＜0.01),near stent tearing was 10.5% (not detected by IVUS),tissue prolapse between coronary stent struts was 52.6% (10.5% in IVUS,P＜0.05).Conclusions OCT imaging is superior to IVUS on detecting vulnerable plaques and change of structure around stents while IVUS is superior to OCT on estimating plaque burden in patients underwent PCI.
