血管内超声指导下冠状动脉支架术后即刻支架膨胀不全相关危险因素分析

摘要

目的 探讨冠状动脉介入治疗术中血管内超声(IVUS)指导下支架膨胀不全发生的相关危险因素.方法 分析同时行术前和术后IVUS检查的102例患者(102个罪犯病变),包括临床特征、造影资料和IVUS数据;支架膨胀率定义为100×最小支架横截面积/参考管腔面积,以中位数分成两组:支架膨胀相对不良组[(66.2±8.8)％]和支架膨胀相对良好组[(88.9±8.0)％],两组患者基线资料比较差异均无统计学意义(均P ＞0.05).比较两组患者血管病变特征,分析支架膨胀不良的相关危险因素.结果 支架膨胀不良组有更多的造影下钙化病变(37.3％ vs 17.7％,P＜ 0.05)和IVUS下钙化病变(76.5％ vs 56.9％,P＜0.05),更大的最大钙化角度[85°(26°,120°)vs 28°(0°,102°),P＜0.05],更长的病变长度[(38.5±10.1)mm vs (30.1±11.4)mm,P＜0.01)],更小的最小支架内面积[(6.0±1.9)mm2 vs(7.7±2.2)mm2,P＜0.01].多变量回归分析发现最大钙化角度(OR=1.21,95％ CI:1.02～1.44,P＜0.05)和病变长度(OR 1.51,95％ CI 1.12～2.04,P＜0.01)是支架膨胀不良的独立危险因素.ROC曲线分析显示预测支架膨胀不良的截点,最大钙化角度是80°,AUC 0.643 (P＜0.01);而病变长度截点是32mm,AUC 0.715 (P＜0.01).结论 尽管有非顺应性后扩球囊辅助扩张,IVUS下支架膨胀不全并不少见,浅表钙化最大角度和病变长度是支架膨胀不全的重要预测因素.%Objective To investigate the risk factors of stent underexpansion in intravascular ultrasound (IVUS)-guided percutaneous coronary intervention (PCI).Methods The clinical data,angiographic and pre-,post-PCI IVUS findings of 102 patients (102 lesions) were reviewed.According to the stent expansion index ≥ median or ＜median,the patients were stratified as stent adequate expansion group (88.9 ± 8.0％) and stent underexpansion group (66.2 ± 8.8％).The clinical features of two groups were compared and the risk factors of stent underexpansion was analyzed.Results There were no significant differences in the baseline characteristics between these two groups.Compared with stent adequate expansion patients,the patients with stent underexpansion had more calcified lesions from both angiographic findings (37.3％ vs 17.7％,P＜0.05) and IVUS measurement (76.5％ vs 56.9％,P＜0.05),larger maximum arc of superficial calcium [85° (26°,120°)vs 28 (0°,102°),P＜0.05],longer lesion length[(38.5 ± 10.1)mm vs (30.1 ± 11.4)mm,P＜0.01)],and smaller minimum stent area [(6.0 ± 1.9)mm2 vs (7.7 ± 2.2)mm2,P＜0.01].Multivariate logistic regression analysis revealed that maximum arcof superficial calcium (OR=1.21,95％ CI:1.02-1.44,P＜0.05) and lesion length(OR=1.51,95％ CI:1.12～2.04,P＜0.01) were independently associated with stent underexpansion.By receiver-operating characteristic (ROC) analysis,the area under curve (AUC) was 0.643 for the maximum arc of superficial calcium and 0.715 for the lesion length.The cut-off values for predicting stent underexpansion were 80° and 32.0 mm,respectively (P＜0.01).Conclusion Stent underexpansion phenomena is not uncommon,despite adjunctive post-dilatation with noncompliant balloon.Extent of superficial calcium and lesion length are the strongest determinants of stent underexpansion.