CAJ | 학술논문

目的利用血管内超声(IVUS)量化分析冠状动脉分叉病变主支(MV)植入支架前后分支血管开口的形状变化,提出分支血管“变形指数(DI)”的概念,并就其在冠状动脉分叉病变介入治疗中的意义做初步探讨.方法收集南方医科大学附属深圳龙华新区人民医院心内科和解放军总医院心内科2005年1月-2013年6月拟行冠状动脉分叉病变介入治疗并血管内超声检查的50例患者的53处病变,利用cross-over技术处理的53处分叉病变,分支血管直径＞2.0 mm.规定能反映血管环形形状的变形指数(DI)概念和计算公式,即血管内超声(IVUS)下,血管管腔的最大、最小直径的差(△D)与最大直径的比(△D/MaxD).理论上,规则圆形的DI为0,DI越偏离0而接近1,血管的椭圆形趋势越大.对比测量分叉病变MV植入支架前后分支血管开口的DI,探讨其影响因素以及与冠状动脉造影(CAG)之间的可能联系.结果术前术后分支血管开口的管腔DI分别为0.18±0.13和0.26±0.16 (P =0.000).多因素分析显示出与DI相关的因素有术前MV病变的偏心指数(P=0.03).主支支架后分支血管开口的DI与冠状动脉造影(QAG)的分支血管开口最小直径(MIN)呈负相关关系(CO:-0.103; P=0.015).偏相关分析法表明,当影响CAG MIN的其他因素得到控制时,DI仍然与CAG MIN有良好的负相关关系(P =0.002).结论冠状动脉分叉病变MV植入支架后分支血管开口呈现出明显的椭圆形趋势,反映其开口形状变化的变形指数(DI)较术前明显增大.DI是术后分支血管CAG最小直径的影响因素之一,可能是造成QAG高估分支血管狭窄加重的原因之一.
목적 이용혈관내초성(IVUS)양화분석관상동맥분차병변주지(MV)식입지가전후분지혈관개구적형상변화,제출분지혈관“변형지수(DI)”적개념,병취기재관상동맥분차병변개입치료중적의의주초보탐토.방법 수집남방의과대학부속심수룡화신구인민의원심내과화해방군총의원심내과2005년1월-2013년6월의행관상동맥분차병변개입치료병혈관내초성검사적50례환자적53처병변,이용cross-over기술처리적53처분차병변,분지혈관직경＞2.0 mm.규정능반영혈관배형형상적변형지수(DI)개념화계산공식,즉혈관내초성(IVUS)하,혈관관강적최대、최소직경적차(△D)여최대직경적비(△D/MaxD).이론상,규칙원형적DI위0,DI월편리0이접근1,혈관적타원형추세월대.대비측량분차병변MV식입지가전후분지혈관개구적DI,탐토기영향인소이급여관상동맥조영(CAG)지간적가능련계.결과 술전술후분지혈관개구적관강DI분별위0.18±0.13화0.26±0.16 (P =0.000).다인소분석현시출여DI상관적인소유술전MV병변적편심지수(P=0.03).주지지가후분지혈관개구적DI여관상동맥조영(QAG)적분지혈관개구최소직경(MIN)정부상관관계(CO:-0.103; P=0.015).편상관분석법표명,당영향CAG MIN적기타인소득도공제시,DI잉연여CAG MIN유량호적부상관관계(P =0.002).결론 관상동맥분차병변MV식입지가후분지혈관개구정현출명현적타원형추세,반영기개구형상변화적변형지수(DI)교술전명현증대.DI시술후분지혈관CAG최소직경적영향인소지일,가능시조성QAG고고분지혈관협착가중적원인지일.
Objective To quantitative analyzing the deformation of SB,by using intravascular ultrasound (IVUS),pre and post MV stenting after cross-over interventional treatment by proposing a concept of " deformation index (DI)".And,Trying to evaluate primarily the significances of such deformation.Methods There were 53 bifurcation lesions treated by cross-over technique.All the diameter of side branch was ＞ 2.0 mm.Proposing the concept of DI as (MaxD-MinD)/MaxD (MaxD,Maximum Diameter; MinD:Minimum Diameter) to present the morphological changes of SB ostium which was measured by IVUS.The DI will be 0 theoretically for a regular round and tend to be a ellipse if close to 1.Comparison analysis the ID of SB pre and post MV stenting and try to observing the effective factor of it and relationship with quantitative coronary angiography (QAG) in coronary bifurcation intervention.Results The DI of SB before and after MV stenting was 0.18 ±0.13 and 0.26 ±0.16(P ＜0.01) respectively,DI was one of correlative factors of MinD of SB ostium measured by QAG(CO:-0.103 ; P =0.015).DI was still the independent factor with QCA-MinD of SB by using partial correlation analysis (P =0.002) when other relative factors were controlled well.Conclusions Ostium of SB showed a obviously ellipse trend after MV stenting in coronary bifurcation interventional treatment.DI was one of relatives of QCA-MinD of SB after procedure and may be one the causes of aggressive QCA-MinD of SB after interventional therapy using cross-over strategy in coronary bifurcation lesion.