van Liebergen R A, Piek J J, Koch K T, Peters R J, de Winter R J, Schotborgh C E, Lie K I
Department of Cardiology, Academic Medical Center, University of Amsterdam, The Netherlands.
J Am Coll Cardiol. 1999 Dec;34(7):1899-906. doi: 10.1016/s0735-1097(99)00450-7.
This study evaluated the acute physiological gain of adjunctive intravascular ultrasound (IVUS) guided balloon angioplasty and stent implantation.
Recent studies indicate safe coronary luminal enlargement and "stent-like" long-term outcomes using upsized balloons guided by IVUS.
After angiographically guided balloon angioplasty in 20 patients with 1-vessel disease and normal left ventricular function, IVUS was performed to determine the size of the adjunctive balloon using the mean of the maximal luminal diameter and the maximal diameter of the external elastic membrane measured in the adjacent proximal and distal reference segments. Serial adenosine-induced hyperemic blood flow velocity measurements were performed using a 0.014" Doppler guide wire to determine the physiological lumen obstruction after standard balloon angioplasty, followed by IVUS-guided balloon angioplasty and stent implantation.
Upsized balloon angioplasty (increase balloon size: 0.98 +/- 0.26 mm; balloon:artery ratio 1.35 +/- 0.21) resulted in an additional increase of arterial dimensions: minimal lumen diameter (MLD) 2.18 +/- 0.38 mm to 2.73 +/- 0.51 mm; percent diameter stenosis (%DS) 34 +/- 13% to 19 +/- 22%; IVUS assessed minimal lumen area (MLA) 7.53 +/- 1.55 mm2 to 10.24 +/- 2.22 mm2 (all p < 0.0001). Major dissections (> or = type C) did not occur. Hyperemic blood flow velocity increased from 49.8 +/- 20.1 cm/s to 59.1 +/- 22.9 cm/s (p < 0.05) after IVUS-guided balloon angioplasty. Adjunctive stent implantation resulted in a further increase of MLD to 3.84 +/- 0.51 mm, %DS to -9 +/- 21% and MLA to 13.39 +/- 1.80 mm2 (all p < 0.0001), while hyperemic blood flow velocity remained unchanged (61.2 +/- 24.7 cm/s, p = 0.7).
Upsized IVUS-guided balloon angioplasty increases arterial coronary dimensions and the distal hyperemic blood flow velocity. Adjunctive stent implantation does not yield a further gain in the hyperemic blood flow velocity, indicating the absence of a functional residual lumen obstruction after IVUS-guided balloon angioplasty. This may explain a similar clinical outcome reported after those coronary interventions.
本研究评估了血管内超声（IVUS）引导下球囊血管成形术和支架植入术的急性生理获益。
近期研究表明，在IVUS引导下使用加大尺寸的球囊可实现安全的冠状动脉管腔扩大及“支架样”的长期预后。
对20例单支血管病变且左心室功能正常的患者进行血管造影引导下的球囊血管成形术后，采用IVUS测量相邻近端和远端参考节段的最大管腔直径和外部弹性膜最大直径的平均值，以确定辅助球囊的尺寸。使用0.014英寸多普勒导丝进行系列腺苷诱导的充血血流速度测量，以确定标准球囊血管成形术后的生理管腔阻塞情况，随后进行IVUS引导下的球囊血管成形术和支架植入术。
加大尺寸的球囊血管成形术（球囊尺寸增加：0.98±0.26mm；球囊与动脉比率1.35±0.21）使动脉尺寸进一步增加：最小管腔直径（MLD）从2.18±0.38mm增加至2.73±0.51mm；直径狭窄百分比（%DS）从34±13%降至19±22%；IVUS评估的最小管腔面积（MLA）从7.53±1.55mm²增加至10.24±2.22mm²（均p<0.0001）。未发生严重夹层（≥C型）。IVUS引导下的球囊血管成形术后，充血血流速度从49.8±20.1cm/s增加至59.1±22.9cm/s（p<0.05）。辅助支架植入使MLD进一步增加至3.84±0.51mm，%DS降至-9±21%且MLA增至13.39±1.80mm²（均p<0.0001），而充血血流速度保持不变（61.2±24.7cm/s，p=0.7）。
IVUS引导下的加大尺寸球囊血管成形术可增加冠状动脉尺寸和远端充血血流速度。辅助支架植入术并未使充血血流速度进一步增加，表明IVUS引导下的球囊血管成形术后不存在功能性残余管腔阻塞。这可能解释了这些冠状动脉介入治疗后报告的相似临床结果。
