股腘动脉经皮腔内血管成形术后斑块面积增加和血管重塑对管腔面积变化的影响：一项血管内超声研究

Plaque area increase and vascular remodeling contribute to lumen area change after percutaneous transluminal angioplasty of the femoropopliteal artery: an intravascular ultrasound study.

作者信息

van Lankeren W, Gussenhoven E J, Honkoop J, Stijnen T, van Overhagen H, Wittens C H, Kranendonk S E, van Sambeek M R, van der Lugt A

机构信息

University Hospital Rotterdam-Dijkzigt, Erasmus University Rotterdam, Sint Franciscus Gasthuis, The Netherlands.

出版信息

J Vasc Surg. 1999 Mar;29(3):430-41. doi: 10.1016/s0741-5214(99)70271-5.

DOI:10.1016/s0741-5214(99)70271-5

PMID:10069907

Abstract

OBJECTIVE

The aim of the study was to assess the change in lumen area (LA), plaque area (PLA), and vessel area (VA) after percutaneous transluminal angioplasty (PTA) of the femoropopliteal artery.

METHODS

This was a prospective study. Twenty patients were studied with intravascular ultrasound (IVUS) immediately after PTA and at follow-up examination. Multiple corresponding IVUS cross-sections were analyzed at the segments that were dilated by PTA (ie, treated sites; n = 168), including the most stenotic site (n = 20) and the nondilated segments (ie, reference sites; n = 77).

RESULTS

At follow-up examination, both the PLA increase (13%) and the VA decrease (9%) resulted in a significant LA decrease (43%) at the most stenotic sites (P =.001). At the treated sites, the LA decrease (15%) was smaller and was caused by the PLA increase (15%). At the reference sites, the PLA increase (15%) and the VA increase (6%) resulted in a slight LA decrease (3%). An analysis of the IVUS cross-sections that were grouped according to LA change (difference >/=10%) revealed a similar PLA increase in all the groups: the type of vascular remodeling (VA decrease, no change, or increase) determined the LA change. At the treated sites, the LA change and the VA change correlated closely (r = 0.77, P <.001). At the treated sites, significantly more PLA increase was seen in the IVUS cross-sections that showed hard lesion or media rupture (P <.05). No relationship was found between the presence of dissection and the quantitative changes.

CONCLUSION

At the most stenotic sites, lumen narrowing was caused by plaque increase and vessel shrinkage. Both the treated sites and the reference sites showed a significant PLA increase: the type of vascular remodeling determined the LA change at follow-up examination. The extent of the PLA increase was significantly larger in the IVUS cross-sections that showed hard lesion or media rupture.

摘要

目的

本研究旨在评估股腘动脉经皮腔内血管成形术（PTA）后管腔面积（LA）、斑块面积（PLA）和血管面积（VA）的变化。

方法

这是一项前瞻性研究。20例患者在PTA后即刻及随访检查时接受血管内超声（IVUS）检查。对PTA扩张的节段（即治疗部位；n = 168）进行多个相应IVUS横截面分析，包括最狭窄部位（n = 20）和未扩张节段（即参考部位；n = 77）。

结果

随访检查时，在最狭窄部位，PLA增加（13%）和VA减小（9%）均导致LA显著减小（43%）（P = 0.001）。在治疗部位，LA减小（15%）较小，是由PLA增加（15%）引起的。在参考部位，PLA增加（15%）和VA增加（6%）导致LA轻微减小（3%）。根据LA变化（差值≥10%）分组分析IVUS横截面发现，所有组中PLA增加情况相似：血管重塑类型（VA减小、无变化或增加）决定了LA变化。在治疗部位，LA变化与VA变化密切相关（r = 0.77，P < 0.001）。在治疗部位，IVUS横截面显示硬斑块或中膜破裂时，PLA增加明显更多（P < 0.05）。未发现夹层的存在与定量变化之间存在关联。