Fuessl R T, Hoepp H W, Sechtem U
University of Cologne, Stuttgart, Germany.
Curr Opin Cardiol. 1999 Nov;14(6):471-9. doi: 10.1097/00001573-199911000-00004.
The main advantage of intravascular ultrasonography (IVUS) over angiography in assessing the effect of coronary interventions is the ability of IVUS to directly visualize the vessel wall. IVUS often reveals a high residual plaque burden after angiographically successful angioplasty, and this can motivate the operator to use additional, more aggressive measures in an attempt to increase lumen dimensions. Studies using IVUS imaging before and after balloon angioplasty have shown that luminal gain after percutaneous transluminal coronary angioplasty (PTCA) results from a combination of plaque reduction and vessel wall stretch. Minimal luminal area and residual area stenosis after PTCA and stent deployment, as measured by IVUS, have been shown to be predictors of restenosis. IVUS studies have pointed to vessel shrinkage, not intimal hyperplasia, as the main mechanism of restenosis after PTCA. IVUS guidance of stent deployment has often revealed inadequate stent expansion despite optimal results on angiography, leading to high-pressure stent deployment with significant additional luminal gain. Restenosis rates may be lower with IVUS-guided stent deployment.
在评估冠状动脉介入治疗效果方面，血管内超声检查（IVUS）相对于血管造影的主要优势在于，IVUS能够直接观察血管壁。血管造影显示血管成形术成功后，IVUS常常揭示出较高的残余斑块负荷，这会促使操作者采取额外、更积极的措施来试图增加管腔直径。在球囊血管成形术前后使用IVUS成像的研究表明，经皮腔内冠状动脉成形术（PTCA）后的管腔增大是斑块减少和血管壁伸展共同作用的结果。通过IVUS测量，PTCA和支架置入术后的最小管腔面积和残余面积狭窄已被证明是再狭窄的预测指标。IVUS研究指出，血管收缩而非内膜增生是PTCA术后再狭窄的主要机制。尽管血管造影结果理想，但IVUS指导下的支架置入常常显示支架扩张不足，从而导致采用高压支架置入并显著增加管腔直径。IVUS指导下的支架置入可能会降低再狭窄率。
