摘要
目的 探讨血管内超声(IVUS)评估冠状动脉钙化病变特征对经皮冠状动脉介入治疗(PCI)术后支架膨胀的影响。方法 271例接受PCI术及IVUS检查患者,根据IVUS检查结果 分为非钙化组(n=101)、钙化组(n=170),钙化组根据临床表型又分为急性冠状动脉综合征(ACS)组(n=123)、稳定型心绞痛(SAP)组(n=47)。比较两组临床基线资料、血管造影和IVUS检查结果,分析支架膨胀不全的影响因素。结果 钙化组患者当前吸烟、多支血管病变比例高于非钙化组(均P<0.05)。PCI术中钙化组旋磨术(RA)、切割球囊(CB)应用比例明显高于非钙化组(均P<0.01),非顺应性球囊(NCB)扩张压力高于非钙化组(P<0.01),支架长度明显长于非钙化组(P<0.01)。SAP组斑块长度、斑块负荷、最大钙化弧度指标高于ACS组(均P<0.05)。ACS组血栓性病变比例高于SAP组,且靶血管存在明显正性重构(P=0.02)。多因素logistic回归分析显示,最大浅层钙化弧度(OR=2.093,95%CI:1.144~3.829,P=0.017)和支架长度(OR=5.371,95%CI:1.696~16.534,P=0.023)与支架膨胀不全密切相关。结论 冠状动脉钙化病变的最大浅层钙化弧度和支架长度与支架膨胀不全密切相关。IVUS对冠脉钙化病变特征判断、PCI术中指导及支架膨胀评估有重要价值。
Objective To evaluate the impact of coronary artery calcium characteristics assessed by intravascular ultrasound(IVUS) on the stent expansion after percutaneous coronary intervention(PCI).Methods A total of 271 patients, who underwent PCI treatment and IVUS examination,were enrolled in this study. According to IVUS examination results, the patients were divided into non-calcification group(n=101) and calcification group(n=170). Based on the clinical characteristics, the patients of calcification group were classified into acute coronary syndrome(ACS) group(n=123) and stable angina pectoris(SAP) group(n= 47). The baseline clinical data, angiographic findings, and IVUS features were compared between the two groups, and the factors affecting the incomplete stent expansion were analyzed. Results The proportion of patients who had current smoking habits and multiple diseased vessels in the calcification group was higher than that in the noncalcification group(P<0.05). During PCI, the proportions of using rotational atherectomy(RA) and using cutting balloon(CB) in the calcification group are higher than those in the non-calcification group(both P<0.01), besides,in the calcification group the expansion pressure of non-compliant balloon(NCB) was higher than that in the non-calcification group(P<0.01), the stent length was remarkably longer than that in the non-calcification group(P<0.01). In SAP group, the plaque length, plaque burden and the maximum calcium arc were significantly higher than those in ACS group(all P<0.05). The proportion of thrombotic lesions in ACS group was higher than that in SAP group, and there were obvious positive remodeling findings in target vessel in ACS group(P=0.02).Multivariate logistic regression analysis indicated that the maximum arc of superficial calcium(OR=2.093,95%CI=1.144-3.829, P=0.017) and stent length(OR=5.371, 95%CI=1.696-16.534, P=0.023) were closely related to the incomplete stent expansion. Conclusion The maximum superficial calcification arc of coronary artery calcified lesions and the stent length are closely related to the incomplete stent expansion. IVUS has important values in judging the characteristics of coronary calcified lesions, in guiding PCI manipulation, and in evaluating expansion condition of stent.
作者
胡司淦
陈天平
陈耀
李辉
康品方
高大胜
HU Sigan;CHEN Tianping;CHEN Yao;LI Hui;KANG Pinfang;GAO Dasheng(Department of Cardiovasology,First Affiliated Hospital of Bengbu Medical College,Bengbu,Anhui Province 233004,China)
出处
《介入放射学杂志》
CSCD
北大核心
2023年第4期354-358,共5页
Journal of Interventional Radiology
基金
安徽省高校自然科学研究重点项目(KJ2021A0818)
蚌埠医学院科技发展基金(BYKF1889)
安徽省高等学校省级质量工程项目(2020jyxm1211)。
关键词
血管内超声
经皮冠状动脉介入治疗
冠状动脉钙化
旋磨术
intravascular ultrasound
percutaneous coronary intervention
coronary calcification
rotational atherectomy
作者简介
通信作者:高大胜,E-mail:gaodasheng612@163.com。
