| Objective: This study was to evaluate the application analysis of intravascular ultrasound(IVUS)in the interventional treatment of chronic total occlusion(CTO)of coronary artery in the detection of lesion characteristics,guidance of stent selection,and balloon dilation and observe the impact of clinical major(Major Advers Cardiovascular Events,MACE)events and the incidence of secondary endpoint events such as postoperative angina recurrence,new-onset arrhythmia,and heart failure.Method:A retrospective analysis of a total of 53 patients with suitable CTO lesions from January 2015 to May 2019 in Yijishan Hospital affiliated to Wannan Medical College,confirmed by bilateral angiography and completed the opening of a CTO lesion vessel,and all were given drugs The eluting stent is implanted and partially expanded after the balloon is completed.Experimental grouping: 21(39.6%)patients who underwent intravascular ultrasound guidance for revascularization were in the IVUS group,and 32(60.4%)patients who underwent revascularization guided CTO lesions were in the contrast group.Senior coronary intervention physicians assess the target vessel diameter and length by visual inspection and other methods to guide the selection of stents and expansion after completion,and maintain conventional drug treatment after operation(aspirin + clopidogrel + atorvastatin,etc.).Then compare the incidence of intraoperative complications and the clinical prognosis between 6 months and 12 months after operation.The primary end point event was to observe thedifference in MACE events between the two groups of patients,while the secondary end point was to observe the incidence of postoperative angina recurrence,new-onset arrhythmia,and heart failure.During the intraoperative examination of the two groups of patients,the IVUS group found calcified lesions,intramural hematoma,guide wire walking under the endometrium,total length of implanted stent,maximum posterior balloon diameter selection(median),and posterior balloon The maximum pressure(median)was higher than the coronary angiography group,and all had significant statistical differences.The rest are in the occlusion vessel distribution in the group,combined with other major vascular lesions(stenosis ?50%),collateral circulation CC classification,diseased vessels with twisted,occlusion length ? 20 mm,postoperative TIMI1-2 grade blood flow,minimum postoperative stent diameter There was no statistically significant difference in the maximum postoperative stent diameter and post-dilatation usage rate(P> 0.05).Results: A total of 53 patients were enrolled in this study,and all of the CTO lesions were successfully opened during hospitalization.They were divided into the IVUS group(n = 21)and the angiography group(n = 32)according to the use of IVUS guidance after the occlusion vessel was opened.The patient's age,gender,hypertension,diabetes,hyperlipidemia,smoking history,serum creatinine(Cr),B-type natriuretic peptide(BNP),left ventricular ejection fraction(LVEF),and previous history of myocardial infarction,There is no statistically significant difference in PCI history or not(P> 0.05).From the results of this study,it was found that 15(71.4%)calcified lesions were found in the IVUS group after the blood vessel was opened,which was higher than 10(31.3%)cases in the contrast group.There was a significant statistical difference between the two groups(P = 0.004);At the same time,4(19.0%)cases of intramural hematoma were found under the guidance of IVUS.The contrast group did not find intramural hematoma.The two groups were statistically different(P= 0.020);the other two groups were walking with guidewire The incidence rate underthe membrane showed that there were 5(23.8%)cases in the IVUS group and 0 cases in the contrast group.There was a statistical difference between the two groups(P =0.016).In terms of the total length of the implanted stent,the length of the stent selected by the IVUS group was significantly greater than that of the contrast group(77.9 ± 23.4 VS 53.4 ± 27.1,P = 0.001);in addition,the maximum diameter of the expanded balloon in the two groups(median)and posterior expansion In terms of the maximum balloon pressure(median),the IVUS group was larger than the coronary angiography group(3.5mm VS 3.0mm,P = 0.009;20atm VS 18 atm,P = 0.001).There were significant statistical differences between the two groups;The patients completed6-12 months of follow-up.The results showed that the incidence of MACE events in the two groups was slightly higher than that in the IVUS group(4.8% vs 12.5%),but there was no statistical difference in the overall events between the two groups.(P =0.644).In the observation of the secondary endpoint,the overall event rate of the two groups of patients in the IVUS group was lower than that of the contrast group,and there was a statistical difference between the two groups [7(33.3%)VS 20(62.5%),P<0.05];Conclusion: The results of this study show that IVUS can more sensitively find the degree of vascular calcification,confirm the position of the guide wire,measure the size of the blood vessel,evaluate the vascular damage caused by the guide wire,guide the choice of stent,and position in the interventional treatment of CTO lesions.At the same time,it can guide post-balloon expansion after stent implantation to optimize stent implantation.The use of IVUS to guide drug-eluting stent implantation in the interventional treatment of CTO lesions is safe and effective.Compared with coronary angiography,it has a tendency to reduce the incidence of postoperative MACE events.It is worth promoting. |
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