目的探讨支架增强显影技术(stentboost,SB)在评价支架植入效果和指导支架内球囊后扩张与血管内超声(intravascular ultrasound,IVUS)的相关性。方法 26例患者在支架植入、支架内球囊后扩张时,完成了冠状动脉造影定量分析(quantative coronary angiography,QCA)、SB技术、IVUS检查,植入支架35枚。分别通过QCA、SB、IVUS获取支架植入、支架内球囊后扩张完成时支架直径,计算支架偏心指数;各项检查所测支架植入、支架内球囊后扩张完成时支架直径和支架偏心指数的自身对照,检查之间所测数据进行相关性分析。结果 QCA、SB、IVUS测量的支架内球囊后扩张完成时支架直径均较支架植入时明显增加,支架偏心指数[(最大支架直径-最小支架直径)/最大血管直径]降低。SB与IVUS测量的支架植入时、支架内球囊后扩张完成时的支架平均直径具有最好的相关性(r=0.982,P0.01;r=0.985,P0.01);而且QCA与IVUS也具有较好的相关性(r=0.975,P0.01;r=0.978,P0.01);QCA与SB也明显相关(r=0.972,P0.01;r=0.976,P0.01)。结论支架内球囊后扩张完成时支架偏心指数较支架植入时更低,与QCA相比,SB与IVUS测量的支架植入时、支架内球囊后扩张完成时的支架平均直径有更好的相关性。

To discuss the correlation between StentBoost(SB)and intravascular ultrasound(IVUS) for assessing stent implantation and guiding the stent post dilatation.Methods Twenty-six patients were analyzed using quantitative coronary angiography(QCA),IVUS,and SB,35 stents were implanted.Twenty-six patients (35 stents)were performed with postdilatation.Stent diameter poststenting and postdilation were measured by QCA,by IVUS by SB respectively;the ratio (maximum stent diameter [MaxLD]-minimum stent diameter [MaxLD]/MaxLD were calculated respectively.Stent diameter were analyzed in poststenting and postdilation check;correlations of three chicks were analyzed.Results The minimum diameter,maximum diameter and average diameter of postdilatation obtained by QCA,IVUS,SB were significantly larger than those of poststenting,and the ratio (maximum stent diameter [MaxLD]-minimum stent diameter [MaxLD]/MaxLD of postdilatation was smaller.Correlations of average diameter were the best between IVUS and SB (

目的探讨血管内超声(IVUS)在ST段抬高型心肌梗死(STEMI)患者急诊介入诊疗中的应用。方法选择冠状动脉造影(CAG)提示心肌梗死相关血管(IRA)固定狭窄为临界病变的STEMI患者80例,发病在12小时内,并且远端血流TIMIⅢ级;随机分为IVUS组(试验组)38例和未行IVUS组(对照组)42例;对照组全部置入支架,试验组进一步经IVUS评价病变分为低危和高危患者,决定是否置入支架;观察两组患者住院期间、术后1个月、3个月、6个月、1年心脏主要不良事件发生率,左心室舒张末期内径(LVEDD)及射血分数(EF)值的变化,支架置入的个数。结果两组患者住院期间、术后1个月、3个月、6个月、1年心脏主要不良事件发生率比较无明显差异,两组LVEDD及EF值比较无明显差异(P0.05);试验组比对照组支架置入的个数减少,差异有显著性(P0.05)。结论在IVUS指导下的急诊介入诊疗中,STEMI低危患者不置入支架也是安全的、可行的,减少了患者支架置入数量。

Objective Explore intravascular ultrasound (IVUS) in patients with acute ST-segment elevation myocardial infarction (STEMI) in the application of emergency intervention. Methods Eighty patients within 12 h of a STEMI episode , who had ifxed stenosis (50%to 75%stenosis) of infraction related artery(IRA) by the coronary angiography (CAG) identiifed as the coronary intermediate lesion ,accompanying with a TIMI 3 lfow at the distal end of the coronary artery, were included. These patients were randomly divided into the IVUS (test group, n=38) and non-IVUS groups (control group, n=42). All the patients in the control group were implanted the stent, while the test group was further divided into the low-risk patients and high-risk patients according to the evaluation of IVUS, and then decided whether implanting the stent or not. We observed the incidence of the major cardiovascular events, the change of the left ventricular end diastolic diameter (LVEDD) and ejection fraction (EF), the number

We describe a patient suffering from late stent thrombosis in a paclitaxel-eluting stent which had an underexpanded ring due to the three-hundred-sixty-degree circumferential calcified plaque. Intravascular ultrasound (IVUS) revealed rotational atherectomy could success-fully ablate both the metallic ring and the calcified ring. The ablated segment was scaffolded with a new paclitaxel-eluting stent, well ex-panded and documented by IVUS. To our knowledge, this is the first case report of stent ablation for an unexpanded paclitaxel-eluting stent. From the Medline index, there were only six case reports of stent ablation. We review and summarize the operation details of stent ablation from these reports.

We describe a patient suffering from late stent thrombosis in a paclitaxel-eluting stent which had an underexpanded ring due to the three-hundred-sixty-degree circumferential calcified plaque. Intravascular ultrasound (IVUS) revealed rotational atherectomy could success-fully ablate both the metallic ring and the calcified ring. The ablated segment was scaffolded with a new paclitaxel-eluting stent, well ex-panded and documented by IVUS. To our knowledge, this is the first case report of stent ablation for an unexpanded paclitaxel-eluting stent. From the Medline index, there were only six case reports of stent ablation. We review and summarize the operation details of stent ablation from these reports.

目的：探讨血管内超声（ IVUS）指导下经桡动脉冠状动脉斑块旋磨术（ RA）联合药物洗脱支架治疗冠状动脉严重钙化病变的有效性。方法回顾性分析2011年3月至2013年3月在浙江大学医学院附属第二医院经冠状动脉造影术确定为严重钙化病变，并在IVUS指导下行经桡动脉RA和置入DES的44例冠心病患者的临床资料，对其临床基本特征、血管造影影像、IVUS影像、RA参数、手术结果、术后严重不良心脏事件（包括死亡、心肌梗死、靶病变血运重建）的发生情况进行分析。患者在RA前后和支架术后进行IVUS检查，评估介入治疗的即刻效果，并指导是否进一步旋磨治疗和球囊后扩张。根据IVUS检查的钙化病变弧度范围，将患者分为A组（90°～270°，共18例）和B组（271°～360°，共26例）。结果 A组和B组的钙化病变弧度分别为（195±71）°和（345±23）°（P＜0.01），钙化病变长度分别为（34.4±11.8）mm和（20.0±6.6）mm（P＜0.05）。使用旋磨头数量和最大旋磨头直径两组之间差异均无统计学意义（ P均＞0.05）。 RA后即刻增加的管腔面积A组和B组分别为（0.43±0.32）mm2和（0.53±0.38）mm2（P＞0.05）。 B组RA后钙化病变弧度与术前比较显著减小[（324±52）°比（345±23）°，P＜0.05]。

Objective To evaluate the efficacy of intravascular ultrasound guided tranradial rotational atherectomy ( RA) followed by drug eluting stent ( DES) implantation in treating patients with heavily calcified coronary lesions.Methods Clinical characteristics , coronary angiogram , intravascular ultrasound images , peri-procedure and follow-up data ( including death , myocardial infarction and target lesion revascularization ) of 44 patients treated with RA and DES implantation under the guidance of IVUS in our department from March 2011 to March 2013 were retrospectively analyzed.IVUS examination was carried out before RA , after RA and stent implantation to guide whether further RA or post dilatation was needed.According to the arc of calcification , the patients were divided into group A (90°-270°,18 cases) and group B (271°-360°,26 cases).Results In A and B group, the arc of calcification was (195 ±71)°in group A and (345 ±23)°in group B(P 0.05).Acute cross sectional a

目的 研究高迁移率族蛋白1 (HMGB1)、髓过氧化物酶(MPO)在预测冠状动脉(冠脉)病变程度和粥样硬化易损斑块破裂中的作用. 方法 对50例急性心肌梗死(AMI)、50例不稳定型心绞痛(UAP)及50例稳定型心绞痛(SAP)患者分别进行冠脉造影(CAG)和选择性血管内超声(IVUS)检查以判断冠脉管腔狭窄程度、斑块性质及斑块破裂和血栓形成情况.30例CAG正常的患者为对照组.酶联免疫吸附法(ELISA)检测4组患者血清HMGB1和MPO的水平,透视免疫法测定高敏C-反应蛋白(hsC-RP)水平.Gensini评分分析冠脉病变程度,相关性分析判断HMGB1、MPO及hsC-RP与IVUS结果和Gensini评分的关系. 结果 AMI和UAP组的HMGB1、MPO及hsCRP血清水平高于SAP组和对照组(均P＜0.01),AMI组高于UAP组(P＜0.05).IVUS结果显示AMI和UAP组主要为脂质性斑块,分别为51.3 ％(20/39)和46.7％(43/92),而SAP组主要为纤维性斑块,脂质斑块仅占17.2％(15/87).与SAP组比较,AMI和UAP组斑块负荷和血管重构指数增大(均P＜0.01).AMI组HMGB1、MPO水平分别与Gensini评分及IVUS测得的重构指数呈正相关(r值分别为0.54、0.48,均P＜0.05),UAP组HMGB1、MPO分别与Gensini评分及IVUS测得的斑块负荷呈正相关(r值分别为0.43、0.56,均P＜0.05). 结论 HMGB1和M

Objective To elucidate the roles of high mobility group box-1 protein (HMGB1) and myeloperoxidase (MPO) deficiency in evaluating coronary stenosis and the vulnerability of atherosclerotic plaques in patients with coronary heart disease.Methods Totally 50 patients with acute myocardial infarction (AMI),50 patients with unstable angina pectoris (UAP),50 patients with stable angina pectoris (SAP) and 30 patients without coronary heart disease underwent the study.Coronary arteriography (CAG) and intravascular ultrasound (IVUS) were performed to analyze coronary stenosis and plaque characteristics and then gensini score was calculated.Concentrations of HMGB1,MPO and hypersensitive C reactive protein (hsC-RP) were measured by means of enzymelinked-immonosorbent assay (ELISA).Results Concentrations of HMGB1,MPO and hsC-RP were significantly higher in AMI and UAP patients than in SAP paticnts (all P＜ 0.01).IVUS showed that 51.3 ％ (20/39) AMI patients,46.7％ (43/92) UAP patients had