通过血管内超声评估冠脉支架贴壁不良的研究进展
Research Advances in the Assessment of Stent Malapposition in Coronary Artery by Intravascular Ultrasound
DOI: 10.12677/ACM.2023.13122631, PDF,    国家自然科学基金支持
作者: 武晓龙, 侯应龙*：山东第一医科大学第一附属医院(山东省千佛山医院)心血管病学，山东省医药卫生心律失常重点实验室，山东 济南；山东第一医科大学(山东省医学科学院)研究生院，山东 济南；王奖荣, 王 聪：山东第一医科大学第一附属医院(山东省千佛山医院)心血管病学，山东省医药卫生心律失常重点实验室，山东 济南
关键词: 经皮冠状动脉介入治疗；血管内超声；支架贴壁不良；预后；Percutaneous Coronary Intervention； Intravascular Ultrasound； Stent Malapposition； Prognosis
摘要: 支架贴壁不良(stent malapposition, SM)现象普遍存在于经皮冠脉介入治疗后，根据发生的时间将支架贴壁不良分为急性支架贴壁不良(acute stent malapposition, ASM)和晚期支架贴壁不良(late stent malapposition, LSM)。LSM可能对术后患者的心肌梗死和晚期支架内血肿的发生有影响，但ASM与预后结局的关系仍有争议。通过血管内超声(intravascular ultrasound, IVUS)评估SM及其对预后的影响时，支架种类可能影响SM的发生率，弥漫性的钙化病变、支架对称性、炎症反应和支架长度等可能是SM的相关危险因素，SM的严重程度和支架内最小面积可能是预测临床结局的有效指标。IVUS在防治支架贴壁不良中具有不可忽视的作用，尤其对于左主干这类疾病的患者行介入干预时。在晚期支架内血栓病变的患者中，SM的发生率更高，此类患者建议长期口服双重抗血小板药物治疗。
Abstract: Stent malapposition (SM) is a common phenomenon after percutaneous coronary intervention (PCI), and it is categorized into acute stent malapposition (ASM) and late stent malapposition (LSM) according to the time of occurrence. LSM may have an impact on the development of myocardial in-farction and late in-stent thrombus in postprocedural patients, but the relationship between ASM and prognostic outcomes remains controversial. When assessing SM and its prognosis by intravas-cular ultrasound (IVUS), stent type may influence the incidence of SM. Diffuse calcified lesions, stent symmetry, inflammatory response and stent length may be relevant risk factors for SM. The severi-ty of SM and the minimal stent area may serve as effective indicators for predicting clinical out-comes. IVUS plays a crucial role in preventing SM, particularly when treating patients with left main coronary artery disease. The incidence of SM is higher in patients with late stent thrombotic lesions, and long-term dual antiplatelet therapy is recommended for such patients.
文章引用：武晓龙, 王奖荣, 王聪, 侯应龙. 通过血管内超声评估冠脉支架贴壁不良的研究进展[J]. 临床医学进展, 2023, 13(12): 18714-18720. https://doi.org/10.12677/ACM.2023.13122631

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