摘要
目的 研究血管内超声(IVUS)评价冠状动脉远端血管弹性对慢性重度狭窄病变开通后血流的影响.方法 以回顾性分析为法,观察对象为2020年12月至2023年9月铜陵市立医院收治的60例慢性重度狭窄病变患者,所有患者均接受经皮冠状动脉介入治疗(PCI)且支架置入成功,并行IVUS检查.参考支架置入后远端血流情况分为研究组(血流减慢,n=12)与对照组(血流正常,n=48),其中研究组患者TIMI血流分级0级或Ⅰ级,对照组患者心肌梗死溶栓治疗试验(TIMI)血流分级≥ Ⅱ级;比较两组造影结果、术中操作特点及IVUS相关资料;同时采用Logistic回归分析慢性重度狭窄病变开通后对血流减慢产生的影响因素.结果 (1)造影结果.两组狭窄段长度、病变血管迂曲、狭窄段钙化、狭窄处分支、顿头狭窄、狭窄段部位、狭窄靶血管比较,差异均无统计学意义(P＞0.05);研究组Rentrop侧支分级1级占比高于对照组,2、3级占比低于对照组,差异均有统计学意义(P＜0.05).(2)术中操作特点.两组患者的冠状动脉穿孔率、远端药物球囊率、支架总长度、支架置入率、正向导丝通过率、逆向开通率比较,差异均无统计学意义(P＞0.05);研究组患者TIMI血流分级0级、Ⅰ级占比高于对照组,Ⅱ、Ⅲ级占比低于对照组,差异均有统计学意义(P＜0.05).(3)IVUS相关资料.两组支架边缘夹层、导丝行走于内膜下、中膜血肿、最大钙化弧度、闭塞段钙化率、近端参考管腔面积、远端参考血管外弹力膜(EEM)面积、近端参考血管EEM面积比较,差异均无统计学意义(P＞0.05);研究组患者远端血管收缩面积、远端血管收缩期面积、远端血管舒张期面积、最小支架面积、最大支架面积、远端参考管腔面积均小于对照组,远端血管弹性差占比高于对照组,差异均有统计学意义(P＜0.05).(4)相关性分析.于Logistic相关性分析中纳入血管弹性、最小支架面积、参考血管管腔面积,结果显示远端血管弹性变差为慢性重度狭窄病变开通后血流减慢独立影响的预测因素(OR=13.74,95％CI:1.945～97.177,P＜0.001),与最小支架面积、血管管腔面积无相关性(OR=0.107,95％CI:0.002～5.932,P=0.276;OR=0.657,95％CI:0.011～35.131,P=0.836).结论 IVUS 评价提示CTO病变远端血管弹性是CTO病变开通后血流减慢的独立危险因素.
Abstract
Objective To investigate the effect of intravascular ultrasonography(IVUS)on blood flow after chronic complete occlusion.Methods Retrospective analysis was performed on 60 patients with chronic severe stenosis lesions admitted to Tongling Municipal Hospital from December 2020 to September 2023.All patients underwent percutaneous coronary intervention(PCI)and stent implantation,and IVUS examina-tion was performed.The remote blood flow after stent implantation was divided into the study group(slowed blood flow,n=12)and the control group(normal blood flow,n=48).The TIMI blood flow grade of the study group was 0 or Ⅰ,and the blood flow grade of the thrombolysis in my-ocardial infarction(TIMI)of the control group was ≥ Ⅱ.The contrast results,operation characteristics and IVUS data were compared between the two groups.At the same time,the factors affecting the slowed blood flow after the opening of chronic severe stenosis lesions was analyzed by Logis-tic regression analysis.Results(1)The result of contrast.There were no statistically significant differences in length of occlusive segment,vessel twisting,occlusive segment calcification,occlusive branch,occlusive head occlusion,location of occlusive segment,and occlusive target vessel between the two groups(P＞0.05);the proportion of Rentrop grade 1 in the study group was higher than that in the control group,and the pro-portion of grade 2 and grade 3 was lower than that in the control group,the differences were statistically significant(P＜0.05).(2)Characteris-tics of intraoperative operation.There were no statistically significant differences in the rate of coronary artery perforation,the rate of distal drug balloon,the total length of stent,the rate of stent placement,the rate of positive wire passage and the rate of reverse opening between the two groups(P＞0.05).The proportion of TIMI blood flow grade 0 and grade Ⅰ in study group was higher than that in control group,and the propor-tion of grade Ⅱ and grade Ⅲ was lower than that in control group,the differences were statistically significant(P＜0.05).(3)IVUS related da-ta.There were no statistically significant differences between the two groups in stent edge dissection,subintimal guide wire walking,mesial hema-toma,maximum arc of calcification,rate of calcification in occlusal segment,area of proximal reference lumen,area of distal reference extravascu-lar elastic membrane(EEM),and area of proximal vascular EEM(P＞0.05).The area of distal vasoconstriction,systolic area,diastolic area,minimum stent area,maximum stent area and distal reference lumen area in the study group were smaller than those in the control group,and the proportion of distal vascular elasticity difference was higher than that in the control group,the differences were statistically significant(P＜0.05).(4)Correlation analysis.In logistic correlation analysis,vascular elasticity,minimum stent area,and reference vascular luminal area were includ-ed,and the results showed that the prediction factor of slow blood flow after opening of CTO lesions was the deterioration of distal vascular elasticity(OR=13.74,95％CI:1.945-97.177,P＜0.01).There was no correlation with minimum stent area,vascular lumen area(OR=0.107,95％CI:0.002-5.932,P=0.276;OR=0.657,95％CI:0.011-35.131,P=0.836).Conclusion IVUS evaluation suggests that dis-tal vascular elasticity is an independent risk factor for decreased blood flow after opening chronic severe stenosis lesions.
基金项目
安徽省高等学校科学研究项目(2023)(2023AH051934)
维普
万方数据