摘要
目的:总结分析本中心应用血管内超声(IVUS)指导慢性闭塞病变(CTO)介入治疗的经验。方法:对897例CTO病变行PCI术患者资料进行分析,所有真性或者功能性CTO病变均纳入,闭塞血管PCI术后达到TIMI 3级血流且残余狭窄<30%为手术成功标准。结果:834例患者897处CTO病变行PCI术,其中765例(85.3%)手术成功,IVUS指导532例(69.5%)。IVUS显示病变处钙化401例(75.4%),72例(13.5%)应用IVUS确定CTO病变的穿刺入口;496例(93.2%)IVUS证实导丝在真腔、精确测量和指导支架置入,65例(12.1%)IVUS指导第2根导丝进入真腔。17例(3.2%)指导反向CART技术。219例(41.2%)发现导丝操作相关的血管损伤,其中90例(16.9%)为导丝在内膜下,99例(18.6%)发现冠状动脉血肿,152例(28.6%)为IVUS发现的冠状动脉穿孔。结论:IVUS显示CTO病变段具有较高钙化发生率,CTO病变处导丝进入内膜下发生率较低。IVUS有助于证实导丝位置、发现导丝操作相关的血管损伤和优化支架置入。
Objective： To retrospectively analysis our center＇s experience and discovery in intravascular ultrasound （IVUS） guiding interventional chronic total occlusion （CTO） therapy.. Method：All 897 patients with CTO were enrolled in study. Both true and functional CTO were included. The operation was considered successful when the occluded vessel had a TIMI HI flow after stent implantation and the residual stenosis was less than 30% at the same time. Result： PCI treatment for 897 CTOs in 834 patients were performed, the operations were successful in 765 eases （85.3%）, and IVUS was performed in 532 cases （69.5%）. IVUS revealed lesion calcification in 401 （75.4%） cases. In 72 （13.5%） cases IVUS was used to determine the CTO lesions puncture entrance, in 496 （93.2 %） cases IVUS were responsible for the comfirmatin of the wire position in true lumen, the accurate vessel measurement and the guidence of stent implantation. In 65 （12. 1%） cases a second wire was introduced into true lumen guided by IVUS when the first wire was in the false lumen. Reverse CART technique was guided by IVUS in 17 （3.2%） cases. In 219 （41.2%） cases guidewire manipulation-related vessel injury was detected by IVUS. IVUS showed subintimal wire position in part of CTO segment in 90 （16.9%） cases, 99 （18.6%） cases of coro- nary hematoma was found, and 152 （28.6%） cases of coronary perforation was detected by IVUS. Conclusion： IVUS showed high incidence of calcification in CTO lesion segment. It is not unusual to find wire penetration in subintimal space in CTO lesion segment. IVUS helps to comfirm wire position, detect guidewire manipulation related vessel injury and optimize the stent inplantation.
出处
《临床心血管病杂志》
CAS
CSCD
北大核心
2013年第12期904-906,共3页
Journal of Clinical Cardiology
关键词
冠状动脉疾病
慢性完全闭塞
血管内超声
coronary heart disease
chronic total occlusion
intravascular ultrasound
