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目的比较血管内超声(IVUS)与传统指导药物涂层支架内再狭窄(ISR)的临床结局。方法纳入2014年1月至2015年6月因药物涂层支架ISR于我院行再次经皮冠状动脉介入治疗的冠心病患者100例。把患者随机纳入血管内超声组(IVUS组)或传统组,每组各50例。IVUS组的患者经造影检查确诊ISR后,马上行IVUS评定ISR的分型,根据分型结果指导治疗。造影检查时记录两组患者的直径狭窄百分数,回顾分析此前两组患者的病变靶血管、支架直径、支架长度以及病变长度。两组患者在出院后3、6、9月电随访患者的全因死亡、主要心血管事件、典型心绞痛发作次数、再次住院次数等情况。出院12月,两组患者均住院再次行造影检查和IVUS检查,再并继续记录上述不良事件的发生情况。结果造影检查的结果显示,两组患者直径狭窄百分数的差异没有统计学意义,两组患者的病变靶血管、支架直径、支架长度以及病变长度的差异均没有统计学意义,可认为两组患者在临床基线水平的支架植入情况相当。12月后所有患者复查造影检查和IVUS检查,造影检查的结果显示,IVUS组的直径狭窄百分数和支架再狭窄均显著低于传统组,而IVUS结果则显示,两组患者在平均支架面积、平均管腔面积、最小支架面积以及平均支架体积的差异均没有统计学意义,IVUS组的平均内膜增生面积、平均内膜增生面积百分数、内膜增生面积百分数、平均内膜增生容积以及平均内膜增生容积百分数均显著少于传统组。两组患者在12个月的随访期内,均没有发生全因死亡或主要心血管事件,其中IVUS组典型心绞痛发作89人次,再住院10人次,传统组典型心绞痛发作151人次,再住院21人次,但差别没有统计学意义。结论与传统指导比较,IVUS指导ISR的治疗,前者可降低支架再狭窄,同时减少患者典型心绞痛的发生次数和再住院次数,这可能与IVUS指导治疗策略的选择能有效抑制血管内膜的增生有关。
Objective To compare the clinical outcomes of intravascular ultrasound (IVUS) with conventional guided drug-coated stent restenosis (ISR). Methods One hundred patients with coronary heart disease undergoing percutaneous coronary intervention in our hospital from January 2014 to June 2015 were enrolled in this study. The patients were randomly assigned to the IVUS group or the conventional group, 50 cases in each group. IVUS group of patients confirmed by angiography ISR immediately after IVUS assessment ISR classification, according to the classification results of the guide treatment. Angiography examination recorded two groups of patients with diameter stenosis percentage, retrospective analysis of the two groups before the lesion target vessel, stent diameter, stent length and lesion length. Patients in both groups were followed up for all-cause death, major cardiovascular events, typical episodes of angina pectoris and number of hospitalizations again in 3, 6, and 9 months after discharge. Discharged in December, two groups of patients were hospitalized again angiography and IVUS examination, and then continue to record the occurrence of the above adverse events. Results The results of contrast examination showed that there was no significant difference in the percentage of diameter stenosis between the two groups. There was no significant difference in target vessel diameter, stent diameter, stent length and lesion length between the two groups. Clinical baseline levels of stent placement are comparable. All patients underwent radiographic and IVUS examinations after December. The results of contrast-enhanced angiography showed that the percentage of diameter stenosis and stent restenosis in IVUS group were significantly lower than those in the conventional group, while the IVUS results showed that the average stent area, mean There was no significant difference in the luminal area, the smallest stent area and the average stent volume. The average intimal hyperplasia area, the average intimal hyperplasia area percentage, the intimal hyperplasia area percentage, the average intimal hyperplasia volume and the average intimal hyperplasia volume in the IVUS group The percentages of proliferative volume were significantly less than those of the traditional group. There were no all-cause deaths or major cardiovascular events during the 12-month follow-up period in both groups, with 89 patients having typical angina pectoris and 10 hospitalizations again in IVUS group, 151 patients having typical angina pectoris in traditional group, 21 more hospitalizations , But the difference was not statistically significant. Conclusion Compared with the traditional guidelines, IVUS can guide the treatment of ISR. The former can reduce stent restenosis and reduce the incidence of typical angina pectoris and rehospitalization, which may be related to IVUS treatment strategy can effectively inhibit the intimal hyperplasia .