Honye J, Saito S, Takayama T, Yajima J, Shimizu T, Chiku M, Mizumura T, Takaiwa Y, Horiuchi K, Moriuchi M, Komaki K, Ozawa Y, Kanmatsuse K, Tobis J M
2nd Department of Internal Medicine, Nihon University School of Medicine, Tokyo, Japan.
Am J Cardiol. 1999 Mar 1;83(5):687-90. doi: 10.1016/s0002-9149(98)00971-0.
Although intravascular ultrasound (IVUS) is used for evaluation of plaque volume and lumen size as well as detection of vessel wall structures after catheter-based interventions, differentiation between the lumen and plaque structures can be difficult. This study attempted to evaluate the efficacy of negative contrast IVUS imaging for assessment of vessel wall morphology after coronary interventions. IVUS studies were performed in 67 lesions in 66 patients before and after coronary interventions. After the baseline ultrasound imaging run, warm 5% glucose solution was injected manually through the guiding catheter into the coronary artery to washout blood from the lumen to avoid speckled reflections from red blood cells (negative contrast). Quantitative measurements were obtained and plaque morphology was assessed for the presence and extent of medial dissections and intimal flaps. There was no difference in each quantitative parameter between baseline images and negative contrast images. The vessel wall boundary was clearly delineated from the lumen, which was defined as effective negative contrast in 51 of 67 lesions (76%). The baseline images revealed plaque dissection in 9 lesions (18%) and an intimal flap in 13 lesions (25%). In addition, 4 dissections (8%) and 16 intimal flaps (31%) were visualized during the infusion of negative contrast. Additional treatment was performed in 4 lesions (8%) based on the images with negative contrast. Negative contrast IVUS was more sensitive in demonstrating a plaque fracture than were baseline images. This method is useful for enhancing the diagnostic capability of IVUS imaging and may influence the decision-making process during interventional procedures.
尽管血管内超声（IVUS）用于评估斑块体积和管腔大小以及在基于导管的干预后检测血管壁结构，但区分管腔和斑块结构可能具有挑战性。本研究试图评估负性对比剂IVUS成像在冠状动脉介入治疗后评估血管壁形态的疗效。对66例患者的67处病变在冠状动脉介入治疗前后进行了IVUS研究。在基线超声成像后，通过引导导管手动向冠状动脉内注入温热的5%葡萄糖溶液以冲洗管腔内的血液，避免红细胞产生的斑点状反射（负性对比）。获得定量测量结果，并评估斑块形态以确定中层剥离和内膜瓣的存在及范围。基线图像和负性对比图像之间的每个定量参数均无差异。血管壁边界与管腔清晰区分，在67处病变中的51处（76%）被定义为有效的负性对比。基线图像显示9处病变（18%）有斑块剥离，13处病变（25%）有内膜瓣。此外，在注入负性对比剂期间，观察到4处剥离（8%）和16处内膜瓣（31%）。基于负性对比图像，对4处病变（8%）进行了额外治疗。与基线图像相比，负性对比IVUS在显示斑块破裂方面更敏感。该方法有助于提高IVUS成像的诊断能力，并可能影响介入手术过程中的决策。
