| BackgroundCoronary atherosclerotic heart disease(CAHD),so called coronary heart disease(CHD),was one of the major diseases that seriously threaten human health and life safety.As a special form of coronary artery sclerosis,left main bifurcation has a high incidence of cardiovascular events.Anatomically,the left anterior descending and left circumflex branches all from the left main are the source of nearly 70% of the blood supply to the heart.Therefore,the accurate diagnosis and treatment of left main bifurcation disease is very important in clinical practice.In the past few decades,it has been widely accepted that coronary angiography is the gold standard for the diagnosis of coronary heart disease.However,coronary angiography only makes indirect judgments through the change of lumen morphology,and only partial information of the lumen and a small amount of information of the tube wall can be obtained through coronary angiography.In addition,coronary angiography is also prone to misdiagnosis of critical lesions.Therefore,coronary angiography has great limitations in the evaluation of coronary lesions,especially in the diagnosis of bifurcation lesions and the determination of the nature of plaques.Since the invention of intravascular ultrasound,it has been widely used in clinical practice.In particular,there are more and more complex coronary artery lesions,and its status in diagnosis and treatment of complex coronary artery lesions and analysis of the nature of plaques is increasingly enhanced.The main reason is that intravascular ultrasound directly delivers ultrasound catheter to the coronary artery,showing the lumen information and the nature of plaques on the wall of the tube directly.Therefore,in the diagnosis and treatment of coronary artery diseases,intravascular ultrasound has become a new standard,which can not only quantitatively assess the degree of lumen stenosis,but also make qualitative analysis of the nature of plaques based on the echoes of the lesions.In addition,it can also help the surgeon to choose the appropriate surgical strategy and the best equipment model,improve the effect of coronary intervention treatment to a higher level,reduce the incidence of cardiovascular adverse events.ObjectiveThe advantages of intravascular ultrasound in the evaluation of single-vessel vascular lesions can bedetermined by previous research results,but there are few studies on bifurcation lesions,especially on left main bifurcation lesions.As the main research direction in this paper,the main discussion intravascular ultrasound in the left main bifurcation lesions to optimize the application of the overview of intravascular ultrasound and coronary artery angiography in left main bifurcation lesions in the inspection method,test results,an analysis of two kinds of inspection to explore the diagnosis and treatment of intravascular ultrasound in the left main bifurcation lesions in effect.MethodA total of 42 patients who were admitted to the department of cardiovascular medicine,Huaihe hospital of Henan university from December 2017 to October 2019 and whose left main bifurcation lesion was revealed by coronary angiography were selected.Coronary angiography and intravascular ultrasound were performed on all patients.Coronary angiography results were analyzed by quantitative coronary angiography(QCA),and intravascular ultrasound results were analyzed by Volcano software system.The proximal length of the main branch and the distal length of the main branch and the minimum lumen diameter(MLD)and diameter stenosis rate(DS)was measured respectively.The results of coronary angiography and intravascular ultrasound were compared in 42 patients.ResultAmong the 42 patients with left main bifurcation disease,28 were 1,1,1 lesions in Medina typing,3were 1,0,1 lesions in Medina typing,and 11 were 0,1,1 lesions in Medina typing.In the measurement of vascular length,the length of main vessel lesion measured by intravascular ultrasound was 25.79±1.92 mm,and that of branch vessel lesion was 14.17±1.69 mm.The length of main vessel lesion measured by coronary angiography was 23.07±1.68 mm,and that of branch vessel lesion was 12.11±1.02 mm,the difference was statistically significant(P<0.05).In the data analysis before interventional treatment,the minimum lumen diameters of the distal and branch vessels measured by intravascular ultrasound group were 1.01±0.36 mm and 1.29±0.41 mm,respectively.These results were all smaller than the 1.16±0.24 mm and 1.41±0.49 measured in the coronary angiography group,with statistically significant differences(P<0.05).In the data analysis after interventional treatment,the minimum diameters of the distal end of the main vessels,the proximal end of the main vessels,the distal end of the main vessels and the branch vessels measured by intravascular ultrasound group were 3.54±0.24 mm,4.04±0.37 mm,3.36±0.40 and 3.10±0.28,respectively.These results were all higher than those of 3.14±0.33,3.49±0.58 mm,2.83±0.23 mm and2.56±0.24 mm in the coronary angiography group,with statistically significant differences(P<0.05).The detection rates of calcified plaque,eccentric plaque,interlayer,plaque rupture,hard plaque,soft plaque and thrombi were 47.6%,83.3%,23.8%,9.5%,30.9%,14.3% and 9.5%,respectively.These results were significantly higher than those of 14.3%,61.9%,9.5%,0,0,0 and 2.4%.The differences were statistically significant in the differentiation of calcified plaque,eccentric plaque,plaque rupture,hard plaque and soft plaque(P<0.05).In the comparison of the status of immediate stent release,the detection rate of poor stent adherence in the intravascular ultrasound group was 21.4%,which was higher than that in the coronary angiography group(4.7%).The difference was statistically significant(P<0.05).ConclusionCoronary angiography may underestimate the stenosis of left main bifurcation and fail to analyze the nature of the plaque.Intravascular ultrasound can accurately assess the stenosis degree of left main bifurcation disease and accurately show the distribution and nature of plaques.Therefore,intravascular ultrasound can directly and accurately diagnose left main bifurcation disease,and then effectively optimize the surgical strategy.At the same time,intravascular ultrasound can more accurately reflect the immediate postoperative stent adherence,and further optimize the therapeutic effect by reducing the incidence of postoperative adverse events. |
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