IVUS在冠脉钙化病变PCI治疗中的临床应用与价值

Clinical Application and Value of IVUS in PCI Treatment of Coronary Artery Calcification Lesions

摘要: 冠状动脉钙化病变显著增加经皮冠状动脉介入治疗(Percutaneous Coronary Intervention, PCI)的难度与风险。血管内超声(Intravascular Ultrasound, IVUS)作为评估钙化的“金标准”，在病变精准识别、分型与量化(如钙化弧度、长度及综合评分)中发挥核心作用。本文系统综述了IVUS如何基于上述评估，引导个体化PCI决策：对轻中度钙化采用阶梯式球囊扩张策略；对具有高危特征(如钙化弧度 ≥ 270˚、评分 ≥ 2分)的重度钙化，则指导选择冠状动脉斑块旋磨术(Rotational Atherectomy, RA)、轨道旋磨术(Orbital Atherectomy, OA)或血管内碎石术(Intravascular Lithotripsy, IVL)等积极预处理。此外，IVUS通过提供客观标准优化支架植入，并被证实能显著改善患者临床预后。展望未来，IVUS成像技术的进步、评估标准的完善，以及与人工智能等新技术的结合，将进一步增强其在钙化病变介入治疗的临床应用价值与预后改善作用。

Abstract: Coronary artery calcification lesions significantly increase the difficulty and risk of Percutaneous Coronary Intervention (PCI). Intravascular Ultrasound (IVUS), as the “gold standard” for evaluating calcification, plays a central role in the precise identification, classification, and quantification of lesions (e.g., calcification arc, length, and comprehensive scoring). This article systematically reviews how IVUS, based on the aforementioned assessments, guides individualized PCI decision-making: employing a stepwise balloon expansion strategy for mild to moderate calcification, while directing the selection of active pretreatment strategies such as Rotational Atherectomy (RA), Orbital Atherectomy (OA), or Intravascular Lithotripsy (IVL) for severe calcification with high-risk features (e.g., maximum calcification arc ≥ 270˚, score ≥ 2). Furthermore, IVUS optimizes stent implantation by providing objective criteria and has been proven to significantly improve clinical outcomes. Looking ahead, advancements in IVUS imaging technology, refinement of evaluation standards, and integration with emerging technologies such as artificial intelligence are expected to further enhance the clinical utility and prognostic value of IVUS in treating calcified lesions.