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目的:在血管内超声(IVUS)指导下,评价雷帕霉素药物洗脱支架(CYPHERTM)置入后球囊后扩张的临床价值。方法:选取72例CYPHERTM置入患者,在IVUS指导下选择支架大小,置入支架后,根据IVUS结果是否满足MUSIC标准分为不需球囊后扩张的支架组(NPB组)和需要球囊后扩张的支架组(PB组),对PB组患者继续用比支架大0.5mm的后扩张球囊1418.2~2026kPa扩张1~4次,反复IVUS检查,直到符合标准。术后6个月内随访观察主要临床心血管事件,满6个月时复查冠状动脉造影和IVUS。结果:球囊后扩张前,PB组支架贴壁状况、支架对称系数、支架最小截面积不满意,和NBP组比较,差异有统计学意义(P<0.01),球囊后扩张后IVUS参数达到标准,2组比较差异无统计学意义(P>0.05),并且球囊后扩张后支架近远端夹层没有明显增加。6个月复查时,2组支架最小截面积、增生内膜面积、面积狭窄率、主要临床心血管事件也差异无统计学意义(P>0.05),但是PB组的面积狭窄率和临床心血管事件有减低趋势。结论:CYPHERTM置入后,在IVUS指导下进行球囊后扩张安全可行,对那些支架扩张不充分的患者能减低再狭窄率和心血管不良事件。
OBJECTIVE: To evaluate the clinical value of post-balloon dilatation of a rapamycin-eluting stent (CYPHERTM) under the guidance of intravascular ultrasound (IVUS). Methods: Seventy-two patients with CYPHERTM were selected. The size of the stent was selected under the guidance of IVUS. After placing the stent into the stent, the stent was divided into NPB group (NPB group) In the expanded stent group (PB group), the patients in PB group continued to expand with 1-418.2-2026kPa for 1 ~ 4 times after the dilatation balloon 0.5mm larger than the stent. IVUS examination was repeated until the standard was met. Follow-up within 6 months postoperatively observed major clinical cardiovascular events and coronary angiography and IVUS at 6 months. Results: Before balloon dilatation, there was a significant difference between the PB group and the NBP group (P <0.01). The IVUS parameters of the balloon group after dilatation Standard, there was no significant difference between the two groups (P> 0.05), and there was no significant increase in the proximal and distal dissection of the stent after balloon dilatation. At the 6-month review, the minimum cross-sectional area, the area of proliferative endothelium, the stenosis rate and the main clinical cardiovascular events were not significantly different between the two groups (P> 0.05). However, the area stenosis rate in PB group and clinical cardiovascular Events have a tendency to decrease. CONCLUSION: Post-balloon dilation is safe and feasible under the guidance of IVUS after CYPHERTM is inserted. Restenosis and cardiovascular adverse events can be reduced in patients with inadequate dilatation of stent.