血管内超声在冠状动脉支架术后再狭窄患者预后影响因素分析中的应用

doi:10.13481/j.1671-587x.20160422

吉林大学学报(医学版) ›› 2016, Vol. 42 ›› Issue (04): 746-752.doi: 10.13481/j.1671-587x.20160422

血管内超声在冠状动脉支架术后再狭窄患者预后影响因素分析中的应用

崔燕¹, 史永锋¹, 郭子源¹, 刘斌¹, 王金鹏¹, 赵雷¹, 王珺楠¹, 朴金花²

1. 吉林大学第二医院心内科, 吉林长春 130041;
2. 延边大学附属医院干部病房, 吉林延吉 133000

收稿日期:2016-01-10 发布日期:2016-07-20
通讯作者: 赵雷,副主任医师(Tel:0431-88796599,E-mail:zhaolei0518@aliyun.com) E-mail:zhaolei0518@aliyun.com
作者简介:崔燕(1967-),女,吉林省长春市人,副教授,医学博士,主要从事冠心病及心律失常的诊断和治疗方面的研究。
基金资助:
国家自然科学基金资助课题（81570250）；吉林省卫计委科研基金资助课题（2012Z070）

Application of intravascular ultrasound in analysis on influencing factors of prognosis in patients with different coronary artery in-stent restenosis

CUI Yan¹, SHI Yongfeng¹, GUO Ziyuan¹, LIU Bin¹, WANG Jinpeng¹, ZHAO Lei¹, WANG Junnan¹, PIAO Jinhua²

1. Department of Cardiology, Second Hospital, Jilin University, Changchun 130041, China;
2. Department of Gerontology, Affiliated Hospital, Yanbian University, Yanji 133000, China

Received:2016-01-10 Published:2016-07-20

摘要/Abstract

摘要：

目的：收集应用血管内超声技术（IVUS）检测发生冠状动脉支架术后支架内再狭窄（ISR）患者的影像学数据及相关资料，分析ISR的危险因素，提出合理的干预策略。方法：将50例ISR患者随机分为ISR≤50%组（药物组）14例和ISR>50%组36例（根据患者意愿及经济情况分为药物球囊治疗组16例和支架治疗组20例）。应用IVUS虚拟组织学技术，比较各组患者采用不同治疗方法治疗前后斑块面积、病变位置、组织构成和血栓等影响预后的因素，并随访6个月后的数据变化。结果：IVUS检测，与术前比较，行介入干预治疗的ISR患者斑块面积和斑块负荷均明显减少（P < 0.05），但药物球囊治疗组患者斑块缩减程度小于支架治疗组（P < 0.05），纤维组织成分无明显变化（P > 0.05），钙化组织所占比例升高，但差异无统计学意义（P > 0.05）。结论：病变狭窄程度高且纤维成分多，斑块成分不均一且分布弥漫伴迂曲钙化的患者ISR发生率均较高。ISR发生与斑块壁厚薄、脂质成分含量、斑块不稳定程度和坏死组织多少无明显关联。

关键词: 支架内再狭窄, 血管内超声, 虚拟组织学, 药物球囊

Abstract:

Objective: To collect the imaging data and related materials of the patients with in-stent restenosis (ISR) after coronary artery stent operation with intravascular ultrasound (IVUS), and to analyze the risk factors of ISR,and to propose the reasonable intervention strategies. Methods: Fifty patients with ISR were divided into ISR ≤ 50% drug group (n=14 ) and ISR >50% drug group(n=36),including drug-coated balloon therapy group (n=16) and stent treatment group (n=20); IVUS virtual organization technology was used to compare the plaque area, location, tissue composition, thrombus and other factors of the patients in various groups after treatment; the data changes after 6 months of follow-up were analyzed. Results: The IVUS results showed the plaque areas and plaque loads of the ISR patients treated with intervention were significantly reduced compared with before operation(P < 0.05);the plaque compression degree of the patients in drug-coated balloon therapy group was lower than that in stent treatment group(P < 0.05), but the differences were not found between drug-coated balloon therapy group and stent treatment group in fibrous tissue components and calcified tissue proportion(P > 0.05). Conclusion: The ISR rate is higher in the patients with high degree of fiber components, plaque composition heterogeneity and distribution of diffuse tortuous and calcified lesions. ISR has no significant correlation with the plaque wall thickness and lipid content and plaque instability and necrotic tissue proportion.

Key words: in-stent restenosis, intravascular ultrasound, virtual histology, drug-coated balloon

中图分类号:

R541.4

崔燕, 史永锋, 郭子源, 刘斌, 王金鹏, 赵雷, 王珺楠, 朴金花. 血管内超声在冠状动脉支架术后再狭窄患者预后影响因素分析中的应用[J]. 吉林大学学报(医学版), 2016, 42(04): 746-752.

CUI Yan, SHI Yongfeng, GUO Ziyuan, LIU Bin, WANG Jinpeng, ZHAO Lei, WANG Junnan, PIAO Jinhua. Application of intravascular ultrasound in analysis on influencing factors of prognosis in patients with different coronary artery in-stent restenosis[J]. Journal of Jilin University Medicine Edition, 2016, 42(04): 746-752.

参考文献

[1] De Caterina AR, Cuculi F, Banning AP. Incidence, predictors and management of left main coronary artery stent restenosis: a comprehensive review in the era of drug-eluting stents[J].Euro Intervention, 2013, 8(11): 1326-1334.

[2] Lowe HC, Oesterle SN, Khachigian LM. Coronary in-stent restenosis: current status and future strategies[J]. J Am Coll Cardiol, 2002,39(2):183-193.

[3] Colombo A, Ruparelia N. Is a drug-eluting stent the default treatment strategy for drug-eluting stent restenosis? [J]. J Am Coll Cardiol, 2015, 66(1): 34-36.

[4] Alfonso F, Sandoval J, Perez-Vizcayno MJ, et al. Mechanisms of balloon angioplasty and repeat stenting in patients with drug-eluting in-stent restenosis[J]. Int J Cardiol, 2015, 178:213-220.

[5] Juszkat R, Stanislawska K, Wasik N, et al. Very late in-stent thrombosis 9 years after double stent treatment of fusiform basilar artery aneurysm[J]. Interv Neuroradiol,2015, 21(3): 329-331.

[6] Nijhoff F, Stella PR, Troost MS, et al. Comparative assessment of the antirestenotic efficacy of two paclitaxel drug-eluting balloons with different coatings in the treatment of in-stent restenosis[J]. Clin Res Cardiol,2016,105(5): 401-411.

[7] Kang SJ, Lee JY, Ahn JM, et al. Validation of intravascular ultrasound-derived parameters with fractional flow reserve for assessment of coronary stenosis severity[J]. Circ Cardiovasc Interv, 2011, 4(1): 65-71.

[8] Ben-Dor I, Torguson R, Deksissa T, et al. Intravascular ultrasound lumen area parameters for assessment of physiological ischemia by fractional flow reserve in intermediate coronary artery stenosis[J]. Cardiovasc Revasc Med, 2012, 13(3): 177-182.

[9] Liu J, Wang Z, Wang WM, et al. Feasibility of diagnosing unstable plaque in patients with acute coronary syndrome using iMap-IVUS[J]. J Zhejiang Univ Sci B, 2015, 16(11): 924-930.

[10] Klersy C, Ferlini M, Raisaro A, et al. Use of IVUS guided coronary stenting with drug eluting stent: a systematic review and meta-analysis of randomized controlled clinical trials and high quality observational studies[J]. Int J Cardiol, 2013, 170(1): 54-63.

[11] Mehilli J, Byrne RA, Tiroch K, et al. Randomized trial of paclitaxel- versus sirolimus-eluting stents for treatment of coronary restenosis in sirolimus-eluting stents: the ISAR-DESIRE 2 (Intracoronary Stenting and Angiographic Results: Drug Eluting Stents for In-Stent Restenosis 2) study[J]. J Am Coll Cardiol, 2010, 55(24): 2710-2716.

[12] Ko YG, Kim JS, Kim BK, et al. Efficacy of drug-eluting stents for treating in-stent restenosis of drug-eluting stents (from the Korean DES ISR multicenter registry study ) [J]. Am J Cardiol, 2012, 109(5): 607-613.

[13] Kufner S, Kastrati A. Drug-eluting stents for drug-eluting stent restenosis: stick with the old or switch to a new one? [J].Coron Artery Dis, 2014, 25(8): 633-635.

[14] Xia HY, Low AF, Lee CH, et al. Treatment of coronary in-stent restenosis with drug-eluting balloon catheter: real-world outcome and literature review[J]. Ann Acad Med Singap, 2013, 42(1): 49-51.

[15] Minha S, Pichard AD, Waksman R. In-stent restenosis of drug-eluting stents[J]. Future Cardiol, 2013, 9(5): 721-731.

[16] Schnorr B, Speck U, Scheller B. Review of clinical data with paccocath-coated balloon catheters[J]. Minerva Cardioangiol, 2011, 59(5): 431-445.

血管内超声在冠状动脉支架术后再狭窄患者预后影响因素分析中的应用

Application of intravascular ultrasound in analysis on influencing factors of prognosis in patients with different coronary artery in-stent restenosis

RichHTML

PDF (PC)

赞

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 1

Metrics

本文评价

推荐阅读 0