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目的评价血管内超声(IVUS)对颈动脉粥样硬化狭窄的诊断和血管内介入治疗的价值。方法本院超声检查显示颈动脉狭窄住院患者17例进行选择性颈动脉造影术(CA)和颈动脉IVUS检查,通过IVUS检查了解病变斑块性质与特征及计算病变血管最大狭窄程度,并对这两种检查结果进行比较。在IVUS指导下支架植入,并观察支架植入前后血管形态学改变。结果CA检测发现狭窄血管21处,偏心性狭窄9处,向心性狭窄12处;IVUS检测发现狭窄血管22处,偏心性斑块17处,向心性斑块5处。病变最窄处血管直径狭窄率IVUS所测值显著高于CA,分别为(66.9±11.2)%与(53.5±12.4)%,两者比较差异有统计学意义(P<0.05)。病变最窄处血管面积狭窄率IVUS所测值显著高于CA,分别为(89.2±12.9)%与(76.1±13.1)%(P<0.05)。颈动脉狭窄支架成形术(CAS)治疗20处血管病变,支架植入均获成功。结论对于CA显示的狭窄病变,IVUS能更准确地判定管腔形态、病变性质及狭窄程度,更有效地指导和评估支架植入。
Objective To evaluate the value of intravascular ultrasound (IVUS) in the diagnosis of carotid atherosclerosis and endovascular interventional therapy. Methods 17 cases of hospitalized patients with carotid stenosis underwent elective carotid artery angiography (CA) and carotid artery IVUS examination in our hospital. The nature and characteristics of lesion plaque and the maximum stenosis of lesion were calculated by IVUS. The two test results are compared. The stents were implanted under the guidance of IVUS and the vascular morphological changes were observed before and after stenting. Results There were 21 stenosis vessels, 9 eccentric stenosis and 12 concentric stenosis. The detection of stenotic vessels by IVUS in 22, eccentric plaques in 17 and concentric plaques in 5 at CAV. The stenosis rate at the narrowest pathological changes of IVUS was significantly higher than that of CA (66.9 ± 11.2)% and (53.5 ± 12.4)%, respectively, with significant difference between the two groups (P <0.05). The stenosis rate of IVUS at the narrowest lesion was significantly higher than that of CA (89.2 ± 12.9)% and (76.1 ± 13.1)%, respectively (P <0.05). Carotid stenosis stenting (CAS) for the treatment of 20 vascular lesions, stent implantation were successful. Conclusions IVUS can determine the shape of the lumen, the nature of the lesion and the degree of stenosis more accurately for the stenosis lesioned by CA and guide and evaluate the stent implantation more effectively.