在择期经皮冠状动脉介入治疗中评估支架扩张时，与血管内超声相比，支架增强造影剂增强效果的评估。
Stent boost enhancement compared to intravascular ultrasound in the evaluation of stent expansion in elective percutaneous coronary interventions.
作者信息
Laimoud Mohamed, Nassar Yasser, Omar Walid, Abdelbarry Akram, Elghawaby Helmy
机构信息
Critical Care Medicine Department-Cairo University, Egypt.
出版信息
Egypt Heart J. 2018 Mar;70(1):21-26. doi: 10.1016/j.ehj.2017.09.001. Epub 2017 Oct 25.
BACKGROUND
Stent underexpansion is a major risk factor for in-stent restenosis and acute in-stent thrombosisIntravascular ultrasound (IVUS) is one of the standards for detection of stent underexpansion (de Feyter et al. 1999; Mintz et al., 2001). StentBoost (SB) enhancement allows an improved angiographic visualization of the stent (Koolen et al., 2005).
AIM OF WORK
Comparison of stent expansion by IVUS and SB enhancement and detection of value of SB to guide dilatation post stent deployment.
METHODOLOGY
IVUS, SB enhancement and QCA were done in 30 patients admitted for elective stenting procedures .We compared measurements of mean ±standard deviations of (Max SD, Min SD, Mean SD, stent symmetry index) using IVUS, SB and QCA after stent deployment and after postdilatation whenever necessary to optimize stent deployment. [(maximum stent diameter minus minimum stent diameter) divided by maximum stent diameter].
RESULTS
The Max SD was (3.45 ± 0.62 vs 3.55 ± 0.56 vs 2.97 ± 0.59) by IVUS vs SB vs QCA respectively. Max SD was significantly higher by IVUS vs QCA (p .009) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .53). The Min SD was (2.77 ± 0.53 vs 2.58 ± 0.56 vs 1.88 ± 0.60) by IVUS vs SB vs QCA respectively. Min SD was significantly higher by IVUS vs QCA (p .001) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .07). The stent symmetry index was (0.24 ±0.09 vs 0.34 ± 0.09 vs 0.14 ±0.27) by IVUS vs SB vs QCA respectively. It was significantly higher by IVUS vs QCA (p .001) and between SB vs QCA (p .001) while there was nonsignificant difference between IVUS vs SB (p .32). SB was positively correlated with IVUS measurements of Max SD (p < .0001 & r 0.74) and Min SD (p < .0001 & r 0.68). QCA was positively correlated with IVUS measurements of Max SD correlation (p < .0001 & r 0.69) and Min SD (p < .0001 & r 0.63). QCA was positively correlated with SB measurements of Max SD (p < .0001 & r 0.61) and Min SD (p .003 & r 0.49).
CONCLUSIONS
StentBoost enhancement has superior correlations for stent expansion measured by IVUS when compared with QCA. SB enhancement improved stent visualization and identification of stent underexpansion to guide stent postdilatation.
背景
支架扩张不足是支架内再狭窄和急性支架内血栓形成的主要危险因素。血管内超声（IVUS）是检测支架扩张不足的标准方法之一（de Feyter等人，1999年；Mintz等人，2001年）。StentBoost（SB）增强技术可改善支架的血管造影可视化（Koolen等人，2005年）。
工作目的
通过IVUS和SB增强技术比较支架扩张情况，并检测SB在指导支架置入术后扩张中的价值。
方法
对30例行择期支架置入术的患者进行IVUS、SB增强技术和定量冠状动脉造影（QCA）检查。我们比较了支架置入后及必要时进行后扩张以优化支架置入后，使用IVUS、SB和QCA测量的（最大标准差、最小标准差、平均标准差、支架对称指数）的平均值±标准差。[（最大支架直径减去最小支架直径）除以最大支架直径]。
结果
IVUS、SB和QCA测量的最大标准差分别为（3.45±0.62、3.55±0.56、2.97±0.59）。IVUS与QCA相比，最大标准差显著更高（p = 0.009），SB与QCA相比也显著更高（p = 0.001），而IVUS与SB之间无显著差异（p = 0.53）。IVUS、SB和QCA测量的最小标准差分别为（2.77±0.53、2.58±0.56、1.88±0.60）。IVUS与QCA相比，最小标准差显著更高（p = 0.001），SB与QCA相比也显著更高（p = 0.001），而IVUS与SB之间无显著差异（p = 0.07）。IVUS、SB和QCA测量的支架对称指数分别为（0.24±0.09、0.34±0.09、0.14±0.27）。IVUS与QCA相比，支架对称指数显著更高（p = 0.001），SB与QCA相比也显著更高（p = 0.001），而IVUS与SB之间无显著差异（p = 0.32）。SB与IVUS测量的最大标准差呈正相关（p < 0.0001，r = 0.74）和最小标准差呈正相关（p < 0.0001，r = 0.68）。QCA与IVUS测量的最大标准差呈正相关（p < 0.0001，r = 0.69）和最小标准差呈正相关（p < 0.0001，r = 0.63）。QCA与SB测量的最大标准差呈正相关（p < 0.0001，r = 0.61）和最小标准差呈正相关（p = 0.003，r = 0.49）。
结论
与QCA相比，StentBoost增强技术在通过IVUS测量支架扩张方面具有更好的相关性。SB增强技术改善了支架的可视化，并有助于识别支架扩张不足，以指导支架后扩张。
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