Honda Y, Yock P G, Fitzgerald P J
Center for Research in Cardiovascular Interventions, Stanford University Medical Center, California 94305, USA.
Catheter Cardiovasc Interv. 1999 Mar;46(3):265-76. doi: 10.1002/(SICI)1522-726X(199903)46:3<265::AID-CCD3>3.0.CO;2-8.
In this study, we summarize the role of residual plaque burden, as determined by intravascular ultrasound, on the development of restenosis following percutaneus coronary interventions. Several clinical trials have shown that the amount of residual plaque is a consistent and independent predictor of subsequent restenosis. The impact of residual plaque burden on late lumen loss is particularly augmented by negative vessel remodeling that is commonly seen after balloon angioplasty and atherectomy. However, early evidence suggests that the importance of plaque burden also applies in the context of stenting. The cotreatment of debulking may further improve the long-term outcome of stenting by maximizing an acute lumen gain with less vessel stretching, preventing stent edge problems and possibly reducing the cell source involved in the intimal hyperplastic process. Evaluation of residual plaque burden with on-line intravascular ultrasound could lead to definitive therapies via risk stratification of the treated segments.
在本研究中，我们总结了通过血管内超声测定的残余斑块负荷在经皮冠状动脉介入治疗后再狭窄发生过程中的作用。多项临床试验表明，残余斑块的数量是后续再狭窄的一个一致且独立的预测指标。球囊血管成形术和旋切术后常见的负性血管重塑会特别增强残余斑块负荷对晚期管腔丢失的影响。然而，早期证据表明，斑块负荷的重要性在支架置入的情况下也同样适用。减容联合治疗可能通过在减少血管拉伸的情况下最大化急性管腔增益、预防支架边缘问题并可能减少内膜增生过程中涉及的细胞来源，进一步改善支架置入的长期效果。使用在线血管内超声评估残余斑块负荷可通过对治疗节段进行风险分层从而实现确定性治疗。
