Tobis Jonathan, Azarbal Babak, Slavin Leo
David Geffen School of Medicine at UCLA, Department of Medicine, Division of Cardiology, Los Angeles, California 90095-1717, USA.
J Am Coll Cardiol. 2007 Feb 27;49(8):839-48. doi: 10.1016/j.jacc.2006.10.055. Epub 2007 Feb 9.
The management of intermediate coronary lesions, defined by a diameter stenosis of 40% to 70%, continues to be a therapeutic dilemma for cardiologists. The 2-dimensional representation of the arterial lesion provided by angiography is limited in distinguishing intermediate lesions that require stenting from those that simply need appropriate medical therapy. In the era of drug-eluting stents, some might propose that stenting all intermediate coronary lesions is an appropriate solution. However, the possibility of procedural complications such as coronary dissection, no reflow phenomenon, in-stent restenosis, and stent thrombosis requires accurate stratification of patients with intermediate coronary lesions to appropriate therapy. Intravascular ultrasound (IVUS) and fractional flow reserve index (FFR) provide anatomic and functional information that can be used in the catheterization laboratory to designate patients to the most appropriate therapy. The purpose of this review is to discuss the critical information obtained from IVUS and FFR in guiding treatment of patients with intermediate coronary lesions. In addition, the importance of IVUS and FFR in the management of patients with serial stenosis, bifurcation lesions, left main disease, saphenous vein graft disease, and acute coronary syndrome will be discussed.
直径狭窄40%至70%所定义的中度冠状动脉病变的管理，仍然是心脏病专家面临的治疗难题。血管造影提供的动脉病变二维图像，在区分需要置入支架的中度病变与仅需适当药物治疗的病变方面存在局限性。在药物洗脱支架时代，有人可能会提出对所有中度冠状动脉病变进行支架置入是一种合适的解决方案。然而，诸如冠状动脉夹层、无复流现象、支架内再狭窄和支架血栓形成等手术并发症的可能性，要求对中度冠状动脉病变患者进行准确分层以采取适当治疗。血管内超声（IVUS）和血流储备分数指数（FFR）提供了解剖和功能信息，可在导管室用于为患者指定最合适的治疗方法。本综述的目的是讨论从IVUS和FFR获得的关键信息，以指导中度冠状动脉病变患者的治疗。此外，还将讨论IVUS和FFR在串联狭窄、分叉病变、左主干病变、大隐静脉桥血管病变和急性冠状动脉综合征患者管理中的重要性。
