[1]张 蛟,段媛媛,魏玉杰,等.支架影像增强显影指导冠状动脉开口病变介入治疗临床应用[J].介入放射学杂志,2015,(08):662-667.
 ZHANG Jiao,DUAN Yuan- yuan,WEI Yu- jie,et al.Clinical application of enhanced visualization of the coronary stent by using stent boost subtract technique in guiding percutaneous coronary intervention for coronary artery ostial lesions[J].journal interventional radiology,2015,(08):662-667.

支架影像增强显影指导冠状动脉开口病变介入治疗临床应用 ()






Clinical application of enhanced visualization of the coronary stent by using stent boost subtract technique in guiding percutaneous coronary intervention for coronary artery ostial lesions
张 蛟 段媛媛 魏玉杰 荆丽敏 贾小伟 徐 瑞 刘惠亮
ZHANG Jiao DUAN Yuan- yuan WEI Yu- jie JING Li- min JIA Xiao- wei XU Rui LIU Hui- liang
Department of Cardiology, General Hospital of Chinese People’s Armed Police Forces, Beijing 100039, China
【关键词】 支架影像增强显影 血管内超声 冠状动脉开口病变 支架释放优化
【摘要】 目的 探讨数字平板血管造影机支架影像增强显影(SBS)技术在指导冠状动脉开口病变介入治疗中的应用效果。方法 收集2012年3月至2014年10月期间武警部队总医院采用经皮冠状动脉介入治疗(PCI)的连续55例冠状动脉开口病变患者的临床资料,对58个开口病变植入支架前后作SBS检查和血管内超声(IVUS)验证。根据支架完全膨胀和精确定位相关标准评价SBS检查和IVUS验证结果。结果 对比IVUS验证结果,SBS技术精确指导PCI手术中48个(48/58,82.8%)病变的支架定位,同时检测到8个(8/58,13.8%)病变为支架膨胀不全。SBS技术预测支架膨胀不全的特异度为100%,灵敏度为80%。SBS检测到的支架管腔最小面积(MSA)与IVUS验证的MSA呈明显正相关(r=0.95,P<0.001)。结论 SBS技术是一种简便易行、能精确提供植入支架定位及支架完全膨胀信息的方法,可常规应用于PCI术治疗冠状动脉开口病变,尤其适用于那些无法开展IVUS检查的临床中心。


[参 考 文 献]
[1] Lemos PA, Hoye A, Goedhart D, et al. Clinical, angiographic, and procedural predictors of angiographic restenosis after sirolimus- eluting stent implantation in complex patients: an evaluation from the Rapamycin- Eluting Stent Evaluated At Rotterdam Cardiology Hospital (RESEARCH) study[J]. Circulation, 2004, 109: 1366- 1370.
[2] Mavromatis K, Ghazzal Z, Veledar E, et al. Comparison of outcomes of percutaneous coronary intervention of ostial versus nonostial narrowing of the major epicardial coronary arteries[J]. Am J Cardiol, 2004, 94: 583- 587.
[3] Freeman M, Clark DJ, Andrianopoulos N, et al. Outcomes after percutaneous coronary intervention of ostial lesions in the era of drug- eluting stents[J]. Catheter Cardiovasc Interv, 2009, 73: 763- 768.
[4] Hur SH, Kang SJ, Kim YH, et al. Impact of intravascular ultrasound- guided percutaneous coronary intervention on long- term clinical outcomes in a real world population[J]. Catheter Cardiovasc Interv, 2013, 81: 407- 416.
[5] Jokhi P, Curzen N. Percutaneous coronary intervention of ostial lesions[J]. EuroIntervention, 2009, 5: 511- 514.
[6] Dishmon DA, Elhaddi A, Packard K, et al. High incidence of inaccurate stent placement in the treatment of coronary aorto- ostial disease[J]. J Invasive Cardiol, 2011, 23: 322- 326.
[7] Puri R, Kapadia SR, Nicholls SJ, et al. Optimizing outcomes during left main percutaneous coronary intervention with intravascular ultrasound and fractional flow reserve the current state of evidence[J]. JACC Cardiovasc Interv, 2012, 5: 697- 707.
[8] Sonoda S, Morino Y, Ako J, et al. Impact of final stent dimensions on long- term results following sirolimus- eluting stent implantation: serial intravascular ultrasound analysis from the sirius trial[J]. J Am Coll Cardiol, 2004, 43: 1959- 1963.
[9] Fujii K, Carlier SG, Mintz GS, et al. Stent underex- pansion and residual reference segment stenosis are related to stent thrombosis after sirolimus- eluting stent implantation: an intravas- cular ultrasound study[J]. J Am Coll Cardiol, 2005, 45: 995- 998.
[10] Cook S, Wenaweser P, Togni M, et al. Incomplete stent apposition and very late stent thrombosis after drugeluting stent implantation[J]. Circulation, 2007, 115: 2426- 2434.
[11] Orford JL, Lerman A, Holmes DR. Routine intravas- cular ultrasound guidance of percutaneous coronary intervention: a critical reappraisal[J]. J Am Coll Cardiol, 2004, 43: 1335- 1342.
[12] Koolen JJ, van het Veer M, Hanekamp CE. StentBoost image enhancement: first clinical experience[J]. Medicamundi, 2005, 49: 4- 8.
[13] Park SJ, Kim YH, Park DW, et al. Impact of intravascular ultrasound guidance on long- term mortality in stenting for unprotected left main coronary artery stenosis[J]. Circ Cardiovasc Interv, 2009, 2: 167- 177.
[14] Jakabcin J, Spacek R, Bystron M, et al. Long- term health outcome and mortality evaluation after invasive coronary treatment using drug eluting stents with or without the IVUS guidance. Randomized control trial. HOME DES IVUS[J]. Catheter Cardiovasc Interv, 2010, 75: 578- 583.
[15] Chieffo A, Park SJ, Valgimigli M, et al. Favorable long- term outcome after drug- eluting stent implantation in nonbifurcation lesions that involve unprotected left main coronary artery. A multicenter registry[J]. Circulation, 2007, 116: 158- 162.
[16] Al- Lamee R, Ielasi A, Latib A, et al. Comparison of long- term clinical and angiographic outcomes following implantation of bare metal stents and drug- eluting stents in aorto- ostial lesions[J]. Am J Cardiol, 2011, 108: 1055- 1060.
[17] Levine GN, Bates ER, Blankenship JC, et al. 2011 ACCF/AHA/SCAI Guideline for Percutaneous Coronary Intervention. A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Society for Cardiovascular Angiography and Interventions[J]. J Am Coll Cardiol, 2011, 58: e44- e122.
[18] 王敬萍, 李 保, 安 健, 等. 冠状动脉血管内超声在冠状动脉介入治疗中的应用[J]. 介入放射学杂志, 2009, 18: 57- 59.
[19] Fischell TA, Saltiel FS, Foster MT, et al. Initial clinical experience using an ostial stent positioning system(Ostial Pro) for the accurate placement of stents in the treatment of coronary aorto- ostial lesions[J]. J Invasive Cardiol, 2009, 21: 53- 59.
[20] Kern MJ, Ouellette D, Frianeza T. A new technique to anchor stents for exact placement in ostial stenoses: the stent tail wire or Szabo technique[J]. Catheter Cardiovasc Interv, 2006, 68: 901- 906.
[21] 莫海亮, 吴 铿, 游 琼, 等. 前降支开口病变经皮冠状动脉介入治疗两种不同术式的临床结果观察[J]. 中国介入心脏病学杂志, 2013, 21: 158- 161.
[22] 高 展, 杨跃进, 陈纪林, 等. 药物洗脱支架精确定位与贯穿左冠状动脉主干治疗冠状动脉前降支口部病变的对照研究[J]. 中华心血管病杂志, 2008, 36: 113- 117.
[23] Jin Z, Yang S, Jing L, et al. Impact of StentBoost subtract imaging on patient radiation exposure during percutaneous coronary intervention[J]. Int J Cardiovasc Imaging, 2013, 29: 1207- 1213.
[24] Okabe T, Kawamura A, Maekawa Y, et al. Can intravascular ultrasound guidance modify the efficacy of drug- eluting stent over bare- metal stent in an aorto- ostial lesion?[J]. Cardiovasc Revasc Med, 2011, 12: 105- 110.
[25] Hassan AK, Bergheanu SC, Stijnen T, et al. Late stent malap- position risk is higher after drug- eluting stent compared with bare- metal stent implantation and associates with late stent thrombosis[J]. Eur Heart J, 2010, 31: 1172- 1180.
[26] Kang SJ, Mintz GS, Park DW, et al. Mechanisms of in- stent restenosis after drug- eluting stent implantation intravascular ultrasound analysis[J]. Circ Cardiovasc Interv, 2011, 4: 9- 14.
[27] Agostoni P, Verheye S. Novel self- expanding stent system for enhanced provisional bifurcation stenting: Examination by StentBoost and intravascular ultrasound[J]. Catheter Cardiovasc Interv, 2009, 73: 481- 487.
[28] Agostoni P, Verheye S. Bifurcation stenting with a dedicated biolimus- eluting stent: X- ray visual enhancement of the final angiographic result with“StentBoost Subtract”[J]. Catheter Cardiovasc Interv, 2007, 70: 233- 236.
[29] Tanaka N, Pijls NH, Koolen JJ, et al. Assessment of optimum stent deployment by stent boost imaging: comparison with intravascular ultrasound[J]. Heart Vessels, 2013, 28: 1- 6.


[1]陈少伯,姜铁民,梁国庆,等.梗死相关动脉粥样斑块的虚拟组织学特点与妊娠相关血浆 蛋白A的相关性研究[J].介入放射学杂志,2011,(01):14.
 CHEN Shao-bo,JIANG Tie-min,LIANG Guo-qing,et al.Characteristics of virtual histology-intravascular unltrasound of infarction-related artery atheromatous plaque and pregnancy-associated plasma protein A level: a correlation study[J].journal interventional radiology,2011,(08):14.
 ,,et al.The intravascular ultrasonographic virtual histology features of the coronary bifurcation lesions [J].journal interventional radiology,2012,(08):274.
 XU Ying-jia,FANG Wei-yi,YANG Xiang-jun..The occurrence and distribution features of calcified nodules in coronary arteries determined by intravascular ultrasonography[J].journal interventional radiology,2011,(08):606.
 XU Zhao-yan,YANG Xi-li..The value of matrix metalloproteinase in predicting the in-stent restenosis after percutaneous coronary intervention procedure[J].journal interventional radiology,2011,(08):363.
[5]岑锦明,熊卿圆,杨希立,等. 糖化血红蛋白与冠状动脉支架术后再狭窄的关系[J].介入放射学杂志,2012,(09):725.
 CEN Jin- ming,XIONG Qing- yuan,YANG Xi- li,et al. Relationship between glycated hemoglobin and restenosis after percutaneous coronary intervention procedure[J].journal interventional radiology,2012,(08):725.
[6]韩玉庆,董力庆,许阳阳,等.血管内超声在1例颈内动脉闭塞患者介入治疗中的应用 [J].介入放射学杂志,2017,(05):447.
 HAN Yuqing,DONG Liqing,XU Yangyang,et al.Clinical application of intravascular ultrasound in the interventional treatment of internal carotid artery occlusion: initial experience of one case[J].journal interventional radiology,2017,(08):447.
[7]李 红,金泽宁,杨 铎,等.衰减斑块对急性心肌梗死患者经皮冠状动脉介入治疗围术期的影响研究[J].介入放射学杂志,2015,(10):849.
 LI Hong,JIN Ze-ning,YANG Duo,et al.The influence of attenuated plaque on perioperative period of percutaneous coronary intervention in patients with acute myocardial infarction[J].journal interventional radiology,2015,(08):849.
[8]梅百强,杨希立,许兆延,等.H型高血压患者斑块特征与同型半胱氨酸相关性研究 [J].介入放射学杂志,2016,(01):70.
 MEI Bai- qiang,YANG Xi- li,XU Zhao- yan,et al.Study on the relationship between plaque imaging characteristics and homocysteine in patients with H- type hypertension [J].journal interventional radiology,2016,(08):70.
 YANG Ya-wei,GU Ying,ZHANG Bi-li,et al.Successful treatment of acute myocardial infarction due to spontaneous intramural hematoma of coronary artery: report of one case [J].journal interventional radiology,2016,(08):552.
[10]刘伟丽,廉哲勋,李大成,等. 支架精显技术在冠状动脉支架植入术中的应用[J].介入放射学杂志,2020,29(07):659.
 LIU Weili,LIAN Zhexun,LI Dacheng,et al.Application of enhanced stent visualization technology in coronary artery stent implantation[J].journal interventional radiology,2020,29(08):659.


(本文编辑:边 佶)
更新日期/Last Update: 2015-08-23