应用IVUS指导DES置入——指征明确，临床疗效好

IVUS-guided DES Implantation More Precise, Yields Better Outcomes

TCT 2008的一篇摘要提醒我们：血管内超声的应用在促进支架技术发展和术后并发症预防方面得到进一步肯定。

由巴西科学家 Costantino O. Costantini博士率领的研究组，连续入选被诊为冠心病且符合DES置入指征的患者1,350例，其中952例在DES置入过程中接受了IVUS指导，其余398例则无。
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入选患者的平均年龄是63岁，平均随访时间是30个月。其中IVUS指导组中多支血管病变和分叉病变患者比例无IVUS指导的患者要高，分别为46% vs. 54%; P = 0.01和 51% vs. 44%; P = 0.03。

在该项研究中，TVF被定义为死亡、MI、支架内血栓和TVR，采用多元回归法分析法进行TVF评价。随访发现：IVUS指导组患者TVF率较非IVUS指导组要低（13.5% vs. 18.8%; P = 0.013），造成这种状况最主要的原因是IVUS指导组支架内血栓发生率要低（0.96% vs. 2.52%; P = 0.02）。而且多支血管病变以及无IVUS指导是TVF的独立预测因子。

Costantini在接受采访时说：长期随访发现，应用IVUS可以通过降低TVF来达到良好的临床疗效。在巴西，我们从1994年开始将IVUS应用于临床，我们相信，IVUS可以提供造影无法显示的更有价值的信息。无论是应用于常规手术还是指导支架治疗，IVUS均可以避免由于操作技术本身造成的失误，如支架大小、直径或者支架长度、支架膨胀程度是否完全以及支架边缘情况等等一系列可能会造成不良结果的因素。

Costantini认为，这些数据表明IVUS是非常重要的工具，应该被广泛应用于导管室，许多支架置入失败的原因，如支架内再狭窄或者支架内血栓都可以通过在术中应用IVUS避免。Costantini同样指出该研究的局限性是现有资料并未显示所有患者氯吡格雷的应用情况，因为从试验一开始时我们并未收集这方面的资料。

（《医心评论》编辑 马秀芹 翻译 刘瑞琦 校对）

（来源：www.tctmd.com）

IVUS-guided DES Implantation More Precise, Yields Better Outcomes 

Key Points:
• IVUS reduces target vessel failure over long-term.

By TCT Daily Staff

Intravascular ultrasound permits better stent deployment and helps avoid technical failures, according to an abstract presented at TCT 2008.

In a retrospective analysis led by Costantino O. Costantini, MD, of the Hospital Cardiologico Costantini in Curitiba, Brazil, 1,350 consecutive patients with CAD and indications for percutaneous coronary intervention with drug-eluting stents were evaluated. A total of 952 patients received IVUS-guided stent implantation, and 398 had the procedure without IVUS.
The IVUS patients were more likely to have multivessel disease (46% vs. 54%; P = .01) and bifurcation lesions (51% vs. 44%; P = .03). The average patient age was 63 years, and the mean follow-up was 30 months.

The researchers conducted logistic regression analysis to identify predictors of target vessel failure, which they defined as death, MI, stent thrombosis, or target vessel revascularization. At follow-up, IVUS patients had lower target vessel failure rates compared with the non-IVUS patients (13.5% vs. 18.8%; P = .013), which was largely due to lower stent thrombosis rates (0.96% vs. 2.52%; P = .02).

Furthermore, both multivessel disease (P < .001) and non-IVUS guidance (P = .01) were found to be independent predictors of target vessel failure.

"IVUS, when used to guide stent deployment, leads to better clinical outcomes by reducing target vessel failure at long-term follow-up," said Costantini in an interview.

"Our group has been using IVUS since 1994 in Brazil," he added. "We believe that IVUS provides valuable information that angiography does not. When guiding stent implantation, whether conventional or DES, IVUS allows better stent deployment. It detects or avoids several technical failures − stent undersizing either in diameter or in length, stent under-expansion, stent incomplete apposition or edge dissection − that certainly will have an impact on clinical outcomes."

According to Costantini, these results suggest that IVUS is an important tool that physicians should utilize more often in cath labs. "Many DES failures − restenosis and thrombosis − are consequences of technical problems during stent implantation that could be avoided if IVUS was used during the procedure," he said.

He noted that a limitation of the study was the failure to document information on clopidogrel use in all patients. "We were not capturing these data at the beginning of this registry," he said.

Disclosures:
• Dr. Costantini reports no conflicts of interest with regard to this study.