南方医科大学学报

南方医科大学学报 ›› 2013, Vol. 33 ›› Issue (07): 1045-.

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血管内超声分析左主干分叉病变主支植入支架后分支血管受累的原因

修建成，廖伟明，刘博，张新渌，侯玉清，黄铮，郭志刚，周忠江，曹世平，崔凯   

  • 出版日期:2013-07-20 发布日期:2013-07-20

Mechanism of lumen loss of the left circumflex ostium after main vessel stent implantation: observations by intravascular ultrasound

  • Online:2013-07-20 Published:2013-07-20

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摘要： 目的探讨左主干分叉病变主支植入支架后分支血管受累的机制。方法28例采用Provisional T策略的LMCA病变，用血
管内超声（Intravascular Ultrasound, IVUS）观察主支置入支架前后及对吻扩张后LMCA远端及分支管腔大小和斑块分布变
化。结果LCX开口部管腔减小由主支支架前的5.9±2 mm2减小到4.9±1.9 mm2，P<0.01；LCX开口部斑块CSA由5.4±2.9 mm2
增加到5.7±2.9 mm2，P=0.21；LCX开口管腔的CSA变化与LCX开口EEM的CSA变化呈正相关，LCX开口管腔CSA变化与斑
块CSA变化无关。球囊对吻前后相比，LCX管腔CSA由4.9±1.9 mm2增大到5.5±1.9 mm2，P<0.01，LCX开口部斑块CSA无明
显变化（5.7±2.9 mm2 vs 5.7±2.6 mm2，P=0.89），LCX开口管腔CSA变化与LCX开口EEM的CSA变化呈正相关，（R=0.432，P=
0.02）。结论LMCA分叉病变主支植入支架后，大多数LCX开口受累的主要原因是血管嵴部移位，部分病例存在LMCA远端
斑块向LCX开口移位；球囊对吻扩张可以改善carina移位，但是不能改善斑块移位。

Abstract: Objective To explore the mechanism of lumen loss of the left circumflex ostium after main vessel stent implantation.
Methods Twenty-eight patients undergoing provisional T technique were enrolled in this study. Intravascular ultrasound
(IVUS) examination was performed before and after main vessel stenting and kissing balloon post-dilatation to evaluate the
geometrical changes of the vessels. Results The CSA of LCX ostium lumen decreased significantly from 5.9±2 mm2 to 4.9±1.9
mm2 (P<0.01) after the procedure, and the CSA of LCX ostium P&M increased from 5.4±2.9 mm2 to 5.7±2.9 mm2 (P=0.21) after
the main vessel stenting. The changes in LCX ostium lumen CSA was correlated with the changes of LCX ostium EEM CSA but
not the LCX ostium P&M CSA. After kissing balloon post-dilatation, the CSA of LCX ostium lumen increased from 4.9±1.9
mm2 to 5.5±1.9 mm2 (P<0.01) , and the CSA of LCX ostium P& M showed no obvious changes (5.7±2.9 mm2 vs 5.7±2.6 mm2, P=
0.89). The changes of LCX ostium lumen CSA were correlated with the those of the LCX ostium EEM CSA (R=0.432, P=0.02).
Conclusion After stent implantation from the LMCA to the LAD, most of lumen losses of the LCX are due to carina shift, and
in occasional cases, plaque shift occurs from the distal LMCA to the ostium of the LCX. Kissing balloon technique can adjust
carina shift but can not improve plaque shift.