Đặc điểm tái hẹp stent động mạch vành trên siêu âm trong lòng mạch (IVUS)

TAP CH[ Y HOC VIEI NAM TAP 463 - THANG 2 - SO 1 - 2018

DAC DIEM TAI HEP STENT DONG MACH VANH

TREN SIEU AM TRONG LONG MACH (IVUS)

TOM TAT

Nghien ciru tren the gidi cho thay viec ket hdp

hinh anh IVUS trong chup mach fle danh gia cac ton

thu'dng nay mang lai tinli chinh xac cao hdn, giai thich

ro rang hdn cho cd che va nguyen nhan tai hep stent

dong mach vanh. Ket qua: Danh gia M vj tri tai hep

> 50% (qua ket qua chup mach qua da). Thdi gian

dat stent: 45,02 ± 33,4 (thang). % tai hep tren IVUS:

67,7± 7,3%. Co 24 (63,2%) ton thu'dng tai cau tnic

am tinh. Noi mac tang smh gap d ca 44 vi tri. 31

(70,4%) VI tri t6n thu'dng co tai hep tai ria stent c6

hoac kiiong kem theo tai hep trong than stent. 12

(27,2%) vi tri stent meo hoac khong ap sat, 19

(43,2%) stent nho hoac nd khong het, 7 (15,9%) v| tri

hep tai cho 2 stent gw nhau. Tai liep diem gap 6

23/44 (52,3%) vi tri. Dien tich stent < 9mm^ gip ii

22/44 (50%) ton thu'dng. Tong chieu dai stent >

40mm: 24 (54,5%). Dien tich stent toi thieu: 8,5 ± 2,8

(mm^) nho hdn so vdi dien tich long mach tham chieu

tfa: 9,5 ± 2,6 (mm^) (p = 0,01). Kei luan: IVUS cho

phep danh gia chinh xac vi tn', hinh thai, ban chat MXV

cua ton thu'dng tai hep, hien lu'dng tai cau true mach

mau va tinh trang stent sau can thiep. Cd che tai tiep

chinh la do tang smh npi mac.

Tit khoa: Chyp dong mach vanh, tai hep stent,

sieu am trong long mach

SUMMARY

MECHANISMS CONTRIBUTING TO IN -

STENT RESTENOSIS CORONARY ARTERY

ON INTRAVASCULAR ULTRASOUND (IVUS)

Previous researchs have shown combining IVUS

image with coronary angiography to provides results

with better acc-uracy and explanation for the

mechanism of ISR. Results; Evaluating 44 ISR position

> 50% (through coronary angiography). Stent

implantation period is 46,02 ± 33,4 months.

Restenosis percentage on IVUS: 67,7±7,3%. 24

positions (63.2%) of negative remodeling injury were

reported. Intimal hyperplasia was reported in all 44

cases. Restenosis with fibrosis plaque and mixed

plaque was reported at 74%, 7 (15,9%) positions

have plaque vulnerability and rupture. 31 (70.4%)

positions were reported with Edge stent restenosis. 12

cases (27.2%) of malapposition or distorted stent, 19

cases (43,2%) in those stents were underexpansion or

undersize, 7 cases (15,9%) of strut stent overlap were

reported. Focal restenosis was reported at 23 (52,3%)

*Vien Tim Mach, Benh vien Bach Mai

Chiu trach nhiem chinh: Nguyen Thi Hai Yen

Email: [email protected]

Ngay nhan bai: 9/12/2017

Ngay phan bien khoa hgc: 08/1/2018

Ngay duyet bai 22/1/2018

Nguyen Thi Hai Yen*, Nguygn Quoc Thai*,

Nguyen Thi Bach Y^n*, Vu Quang Nggc*

positions. 22 (50%) positions have stent area under

9mml MLSA: 8,5 ± 2,8 (mm^) smaller Oian that of

minimal lumen reference area: 9,5 ± 2,6 (mm^)

(D=0,01). Conclusion: IVUS allows us to assess the

characterization of plaque types, restenosis stent

locations, restenosis morphology, phenomenon of

vascular remodeling, and post-intervention stent

conditions. In most IRS, IH was the dominant

mechanism of ISR.

Keywords: Coronary angiography, m-stent

restenosis (ISR), intravascular ultrasound (IVUS)

L OAT VAN OE

Tai hep sau can thiep dpng mach vanh van

con la mot van de ma benh nhan va bac sT dang

phai doi mat. Co tdi 20 - 30% so benh nhan

phai can thiep lai sau I nam vl tai hep hoac vi

phat trien them cua ton thu'dng [I] . Sieu am

trong long mach-IVUS (Intravascular ultrasound)

la phu'Ong phap chan doan hinh anh su" dung

nguyen ly sieu am danh gia ton thu'dng trong

long dong mach vanh. Nghien ciJu cac hinh anh

tai hep stent tren chup mach giup hieu ro hdn ve

nguyen nhan tai hep va chi dinh phtfdng phap tai

can thiep thich hdp. Tuy nhien, mot so nghien

CLTU tren the gidi clio thay viec ket hdp hinh anh

IVUS trong chup mach giup danh gia tai hep

chi'nh xac hdn, giai thich ro rang hdn cho cd che

va nguyen nhan tai hep stent dong mach vanh

[2], Chfnh vi nhiing ly do tren nghien ciJu du'dc

tien hanh vdi muc tieu: Mo ta mgt so dac diem

tai hep stent dpng mach vanh tren sieu am trong

long mach (intravascular ultrasound - IVUS).

II. £>6l TUONG VA PHUOIMG PHAP NGHIEN COXJ

Nghien ciJu du'dc tien hanh tif thang 11/2015

den thang 9/2017, tai Vien Tim mach - Benh vien

Bach Mai.

2.1. Doi tu'tfng nghien cu'u: TiSu chuan

Ivta chgn: benh nhan du'dc chan doan tai hep

stent dong mach vanh > 50% (qua ket qua

chup mach qua da), cd tinh tran huyet dong on

dmh. Tieu chuan loai trtt: t^i hep du'di 50%

tren chup mach qua da, hoac tinh trang huyet

dong khong on djnh (suy tim nang, soc tim).

2.2. Phifdng phap nghien cu'u

*Thiet ke nghien c&u: mo ta cat ngang.

*Mau nghien CL/V: gom 41 benh nhan cd du

tieu chuan lu'a chon va loai trCr, Vdi each chon

mau thuan tien.