中国组织工程研究与临床康复
中國組織工程研究與臨床康複
중국조직공정연구여림상강복
JOURNAL OF CLINICAL REHABILITATIVE TISSUE ENGINEERING RESEARCH
2008年
30期
5979-5984
,共6页
倪祝华%杨新春%王乐丰%葛永贵%王红石%夏昆%李惟铭%徐立%迟永辉%刘宇
倪祝華%楊新春%王樂豐%葛永貴%王紅石%夏昆%李惟銘%徐立%遲永輝%劉宇
예축화%양신춘%왕악봉%갈영귀%왕홍석%하곤%리유명%서립%지영휘%류우
血管内超声%冠状血管造影%支架置入%冠状动脉疾病
血管內超聲%冠狀血管造影%支架置入%冠狀動脈疾病
혈관내초성%관상혈관조영%지가치입%관상동맥질병
背景:支架扩张不充分以及与操作相关的异常病变形态是支架内再狭窄以及急性、亚急性和慢性支架内血栓形成的重要原因.目的:观察应用血管内超声指导支架置入能否获得更大的支架内管腔面积,能否发现更多与操作相关的并发症.设计、时间及地点:回顾性病例分析,于2004-01/2005-02在首都医科大学附属北京朝阳医院心脏中心进行.对象:选择50 例患者的52 处在血管内超声指导下行支架置入的病变进行分析.入选患者均为自体冠状动脉非弥漫性病变,血管直径≥ 2.5 mm,严重的左主干病变除外.方法:50 例患者的52 处病变在支架置入前后分别用血管造影和血管内超声进行定量和定性分析,并根据血管内超声标准决定支架的直径以及置入的终点.主要观察指标:分析血管造影和血管内超声对支架置入终点判断的差异和最终获得的管腔面积大小的差别.结果:①血管内超声判断的平均支架直径大于血管造影(P=0.011),支架囊的最终峰值压力明显增大(P < 0.001),定量冠状动脉造影测得的支架面积狭窄百分比减小(P =0.044).②首次高压扩张后支架满意率血管造影达96.2%,而血管内超声只有37.7%.③血管内超声指导后最终的球囊压力更高(P < 0.001),获得的管腔直径更大(P < 0.001),管腔面积也更大(P < 0.001),面积狭窄百分比更小(P < 0.001).④所有患者支架的近段和远段血管造影均未发现明显的狭窄.而血管内超声却发现支架近段血管有39 例(75.0%),远段血管有23 例(44.2%)存在动脉粥样硬化斑块.⑤支架置入后非脂质斑块较脂质斑块获得的管腔面积更大(P < 0.001),其中脂质斑块血管面积增大较非脂质斑块小1.30 mm2,斑块压缩程度却增加0.48 mm2.结论:血管内超声能更好地指导支架选择,获得更大的管腔面积,也能更精确地发现操作相关的并发症.
揹景:支架擴張不充分以及與操作相關的異常病變形態是支架內再狹窄以及急性、亞急性和慢性支架內血栓形成的重要原因.目的:觀察應用血管內超聲指導支架置入能否穫得更大的支架內管腔麵積,能否髮現更多與操作相關的併髮癥.設計、時間及地點:迴顧性病例分析,于2004-01/2005-02在首都醫科大學附屬北京朝暘醫院心髒中心進行.對象:選擇50 例患者的52 處在血管內超聲指導下行支架置入的病變進行分析.入選患者均為自體冠狀動脈非瀰漫性病變,血管直徑≥ 2.5 mm,嚴重的左主榦病變除外.方法:50 例患者的52 處病變在支架置入前後分彆用血管造影和血管內超聲進行定量和定性分析,併根據血管內超聲標準決定支架的直徑以及置入的終點.主要觀察指標:分析血管造影和血管內超聲對支架置入終點判斷的差異和最終穫得的管腔麵積大小的差彆.結果:①血管內超聲判斷的平均支架直徑大于血管造影(P=0.011),支架囊的最終峰值壓力明顯增大(P < 0.001),定量冠狀動脈造影測得的支架麵積狹窄百分比減小(P =0.044).②首次高壓擴張後支架滿意率血管造影達96.2%,而血管內超聲隻有37.7%.③血管內超聲指導後最終的毬囊壓力更高(P < 0.001),穫得的管腔直徑更大(P < 0.001),管腔麵積也更大(P < 0.001),麵積狹窄百分比更小(P < 0.001).④所有患者支架的近段和遠段血管造影均未髮現明顯的狹窄.而血管內超聲卻髮現支架近段血管有39 例(75.0%),遠段血管有23 例(44.2%)存在動脈粥樣硬化斑塊.⑤支架置入後非脂質斑塊較脂質斑塊穫得的管腔麵積更大(P < 0.001),其中脂質斑塊血管麵積增大較非脂質斑塊小1.30 mm2,斑塊壓縮程度卻增加0.48 mm2.結論:血管內超聲能更好地指導支架選擇,穫得更大的管腔麵積,也能更精確地髮現操作相關的併髮癥.
배경:지가확장불충분이급여조작상관적이상병변형태시지가내재협착이급급성、아급성화만성지가내혈전형성적중요원인.목적:관찰응용혈관내초성지도지가치입능부획득경대적지가내관강면적,능부발현경다여조작상관적병발증.설계、시간급지점:회고성병례분석,우2004-01/2005-02재수도의과대학부속북경조양의원심장중심진행.대상:선택50 례환자적52 처재혈관내초성지도하행지가치입적병변진행분석.입선환자균위자체관상동맥비미만성병변,혈관직경≥ 2.5 mm,엄중적좌주간병변제외.방법:50 례환자적52 처병변재지가치입전후분별용혈관조영화혈관내초성진행정량화정성분석,병근거혈관내초성표준결정지가적직경이급치입적종점.주요관찰지표:분석혈관조영화혈관내초성대지가치입종점판단적차이화최종획득적관강면적대소적차별.결과:①혈관내초성판단적평균지가직경대우혈관조영(P=0.011),지가낭적최종봉치압력명현증대(P < 0.001),정량관상동맥조영측득적지가면적협착백분비감소(P =0.044).②수차고압확장후지가만의솔혈관조영체96.2%,이혈관내초성지유37.7%.③혈관내초성지도후최종적구낭압력경고(P < 0.001),획득적관강직경경대(P < 0.001),관강면적야경대(P < 0.001),면적협착백분비경소(P < 0.001).④소유환자지가적근단화원단혈관조영균미발현명현적협착.이혈관내초성각발현지가근단혈관유39 례(75.0%),원단혈관유23 례(44.2%)존재동맥죽양경화반괴.⑤지가치입후비지질반괴교지질반괴획득적관강면적경대(P < 0.001),기중지질반괴혈관면적증대교비지질반괴소1.30 mm2,반괴압축정도각증가0.48 mm2.결론:혈관내초성능경호지지도지가선택,획득경대적관강면적,야능경정학지발현조작상관적병발증.
BACKGROUND: Stent under-expansion and procedurally related abnormal lesion morphologies (e.g. dissection, thrombus) are associated with stent restenosis and acute, subacute and chronic thrombosis.OBJECTIVE: To explore whether larger post-procedural final minimum stent area can be acquired and more procedurally related complications can be identified in stent implantation guided by intravascular ultrasound.DESIGN, TIME AND SETTING: Retrospective analysis was performed at the Heart Center of Beijing Chaoyang Hospital, Capital Medical University between January 2004 and February 2005.PARTICIPANTS: Fifty patients with coronary artery disease with 52 lesions were enrolled in the study and underwent stenting guided by intravascular ultrasound. The patients were characterized as non-diffused lesion with vessel diameter ≥ 2.5 mm. Patients with severe left main lesion were excluded.METHODS: Qualitative and quantitative analyses were carried out in 50 patients with 52 lesions before and after stent implantation. The stent diameter and the end-point of therapy were determined by intravascular ultrasound standard.MAIN OUTCOME MEASURES: The differences of end point for stent implantation and the enlargement of lumen area gained by stent implantation were compared between cardioangiography and by intravascular ultrasound.RESULTS: The average stent diameter guided by intravascular ultrasound was larger than by cardioangiography (P=0.011); the peak balloon pressure was higher in intravascular ultrasound group than cardioangiography group (P < 0.001), and area stenosis percentage measured by quantitative coronary angiogram was smaller in intravascular ultrasound group than cardioangiography group (P=0.044). ②Cardioangiography showed success rate was 96.2% and intravascular ultrasound showed the success rate was only 37.7% after first balloon high-pressure dilation. Intravascular ultrasound subgroup analysis showed higher peak balloon pressure (P < 0.001), larger lumen diameter (P < 0.001), larger lumen area (P < 0.001), and smaller area stenosis percentage (P < 0.001). No obvious stenosis was found at the proximal and distal segments of the stent observed by cardioangiography, while atherosclerotic lesions at proximal segment were found in 39 cases (75.0%) and at distal segment were in 23 cases (44.2%) observed by intravascular ultrasound. The lumen area was larger in non-fatty plaque than in fatty plaque after stent implantation (P < 0.001). Compared with non-fatty plaque, the enlargement of vessel area was 1.30 mm2 smaller, while plaque compression was 0.48 mm2 larger. CONCLUSION: Stent implantation guided by intravascular ultrasound can acquire larger final lumen area and identify more procedurally related complications.
