冠状动脉支架术后再狭窄发生机制的血管内超声观察 - 论文中心

作者：李俊峡，鹰津良树，宫本忠司，永井康三，加藤贵雄
【关键词】超声检查,介入性；冠状血管造影术；冠状动脉再狭窄；支架
    【Abstract】 AIM: To investigate the instent restenosis process by coronary artery angiography (CAG) and intravascular ultrasound(IVUS). METHODS: The study consisted of 92 patients with 118 stents(LAD53, LCX32, RCA33). Followup CAG and IVUS were performed 6 months after stent placement. There were 39 stents with and 79 stents without instent restenosis by CAG. The reference areas, minimal stent crosssectional areas(CSA), minimal stent luminal CSA, intimal hyperplasia CSA, stent lumen and intimal hyperpla volume were measured by IVUS. RESULTS: Reference areas, minimal stent CSA and stent volume had no significant differences between restenotic and nonrestenotic stents(P>0.01). Restenotic stents had smaller minimal stent luminal CSA ［（2.3±1.1）mm2 vs (5.4±1.8) mm2, P＜0.01］ than nonrestenotic stents, but had bigger intimal hyperplasia CSA and intimal hyperplasia volume than nonrestenotic stents ［（4.7±1.5） mm2 vs (1.6±0.8) mm2, (121.1±31.9) mm3 vs (54.3±11.4) mm3, P＜0.01〕.CONCLUSION: Intimal hyperplasia was important in the development of instent restenosis. But the vascular remodeling and the degree of stent dilation had no obvious relationship with instent restenosis.
    【Keywords】 ultrasonography, interventional; coronary angiography; coronary restenosis; stents
    【摘要】目的：应用冠状动脉造影（CAG）及血管内超声（IVUS）研究冠脉内支架术后再狭窄的发生机制. 方法：以成功留置冠脉内支架，于6 mo后进行复查的92名患者118处病变（其中前降支53处病变、回旋支32处病变、右冠状动脉33处病变）为对象，进行CAG及IVUS检查，以CAG直径狭窄率≥50%为支架内再狭窄. 根据冠状动脉造影结果将患者分为支架再狭窄组（39例）和无再狭窄组（79例），通过IVUS观察两组冠脉内支架术后及随访时参考段血管面积、最小支架截面积、最小血管内膜腔截面积、新生内膜面积、支架体积及新生内膜体积. 结果：两组支架置入术后即刻及随访时参考段血管面积、最小支架截面积、支架体积无显著性差异 (P>0.01)，随访时再狭窄组最小血管内膜腔截面积较无再狭窄组明显减小［（2.3±1.1） mm2 vs (5.4±1.8) mm2, P＜0.01］；而新生内膜面积及体积较无再狭窄组明显增大［（4.7±1.5）mm2 vs (1.6±0.8) mm2, (121.1±31.9) mm3 vs (54.3±11.4) mm3, P<0.01］. 结论：支架内再狭窄主要以内膜增生为主，而与血管重构及支架弹性回缩无明显关系.
    【关键词】超声检查，介入性；冠状血管造影术；冠状动脉再狭窄；支架
    0引言
    冠状动脉支架置入术是治疗冠状动脉阻塞性病变的重要方法，能改善经皮冠状动脉腔内成形术（PTCA）的再狭窄率［1］，但支架术后仍有20%～30%的患者发生再狭窄，是制约其临床效果的主要因素，探讨支架术后再狭窄的发生机制有着重要意义. 血管内超声波法（intravascular ultrasound, IVUS）是近几年来发展起来的一种新的介入技术，不仅能够反映血管腔内的变化，同时也能反映含斑块在内的血管横断面结构以及斑块的性状等［2］，因此IVUS也可以称为实时的关于血管结构的低倍镜病理图像，在冠心病的诊断及再狭窄的发生机制中可以发挥重要的作用［3-5］. 我们应用IVUS探讨支架术后再狭窄的发生机制.
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