Yamaguchi T, Hamasaki S, Arima S, Biro S, Kihara K, Fukumoto N, Kamekou M, Nakano F, Yoshitama T, Kiyonaga K, Nakajima H, Nakao S, Tei C
First Department of Internal Medicine, Faculty of Medicine, Kagoshima University, Japan.
Jpn Heart J. 1999 Mar;40(2):109-18. doi: 10.1536/jhj.40.109.
The purpose of this study was to evaluate the rupture and dissection of the vessel wall immediately after balloon dilatation by intravascular ultrasound (IVUS) imaging and to predict restenosis in patients who underwent subsequent coronary stent implantation. Stent implantation improves the long-term results of coronary angioplasty by reducing lesion elastic recoil and arterial remodeling. However, several studies have suggested that neointimal hyperplasia is the cause of instant restenosis. We recruited 60 patients in whom IVUS studies were performed immediately after successful balloon dilatation and just before stent implantation. We compared IVUS parameters with 6-month follow-up quantitative coronary angiography. This was performed in 51 lesions of 51 patients (85%). Qualitative analysis included assessment of plaque composition, plaque eccentricity, plaque fracture and the presence of dissection. In addition, minimal luminal diameter, percent diameter stenosis, percent area stenosis and plaque burden were quantitatively analyzed. Two morphological patterns after balloon dilatation were classified by IVUS. Type I was defined as absence or partial tear of the plaque without disclosure of the media to lumen (22 lesions). Type II was defined as a split in the plaque or dissection of the vessel wall with disclosure of the media to the lumen (29 lesions). At 6 months follow-up, angiographic restenosis occurred in 17 of the 51 lesions (33%). Restenosis was significantly (p < 0.05) more likely to occur in type II (13/29: 45% incidence) than in type I (4/22: 18% incidence). The assessment of plaque morphology immediately after balloon dilatation and before stent implantation provides important therapeutic and prognostic implications.
本研究的目的是通过血管内超声（IVUS）成像评估球囊扩张后即刻血管壁的破裂和夹层情况，并预测随后接受冠状动脉支架植入患者的再狭窄。支架植入通过减少病变弹性回缩和动脉重塑改善了冠状动脉血管成形术的长期效果。然而，多项研究表明，内膜增生是即刻再狭窄的原因。我们招募了60例患者，在成功球囊扩张后即刻且在支架植入前进行IVUS检查。我们将IVUS参数与6个月随访时的定量冠状动脉造影进行比较。这在51例患者的51处病变（85%）中进行。定性分析包括斑块成分、斑块偏心性、斑块破裂和夹层的评估。此外，还对最小管腔直径、直径狭窄百分比、面积狭窄百分比和斑块负荷进行了定量分析。通过IVUS对球囊扩张后的两种形态学模式进行分类。I型定义为斑块无撕裂或部分撕裂，中膜未暴露于管腔（22处病变）。II型定义为斑块裂开或血管壁夹层，中膜暴露于管腔（29处病变）。在6个月随访时，51处病变中有17处（33%）发生了血管造影再狭窄。II型病变（13/29：发生率45%）比I型病变（4/22：发生率18%）更易发生再狭窄，差异有统计学意义（p < 0.05）。球囊扩张后即刻且在支架植入前对斑块形态的评估具有重要的治疗和预后意义。
