Choi J W, Vardi G M, Meyers S N, Parker M A, Goodreau L M, Davidson C J
Northwestern University Medical School, Chicago, IL 60611, USA.
Am Heart J. 2000 Apr;139(4):643-8. doi: 10.1016/s0002-8703(00)90042-5.
Poststent high-pressure balloon inflation has been shown to improve clinical outcomes. However, it is unknown whether intracoronary ultrasound (ICUS) provides additional clinical guidance after initial high-pressure balloon inflation is used during stent placement. Thus the purpose of this study was to determine if stent deployment techniques are improved with ICUS imaging despite an optimal angiographic result achieved with high-pressure balloon inflation.
Prospective data were collected on 96 consecutive patients in whom 151 stents were deployed. Stents and high-pressure balloons were angiographically sized 1:1 by visual estimation. High-pressure (> or =12 atm in all cases) balloon inflations were continued until angiographic completion (<10% residual stenosis), after which index ICUS imaging was performed. Stent apposition, symmetry, and lumen dimensions were evaluated. An optimal ICUS result was defined as full apposition of the stent, symmetry ratio > or =0.80, and acute gain > or =0.80 of the reference lumen area. If inadequate ICUS results were found, further dilations with higher pressures or larger balloons and subsequent stent reevaluation with ICUS were performed. Sixty-nine (46%) stents required additional balloon inflations. Of these stents, 35 (23%) had initial acute gains that were <80% of the reference lumen area. Forty-six (30%) stents were found to have unapposed struts and 24 (16%) had a symmetry ratio <0.80. In patients requiring additional inflations, minimum stent area increased from 7.6 +/- 2.2 mm(2) to 9.2 +/- 2.4 mm(2) (P <.0001). Similarly, complete stent apposition improved from 33% to 68% of total stents (P <.0001). After initial ICUS, higher-pressure dilations were performed in 40 patients, whereas larger balloons greater than or equal to ICUS reference vessel diameter were used in 33 patients. Follow-up was obtained in 95 (99%) patients. The overall major adverse cardiac event rate at 6 months was 9.3%, which consisted of 8 target vessel revascularizations and 1 abrupt closure requiring repeat intervention.
Even when poststent high-pressure balloon inflation achieves an optimal angiographic result, ICUS assists in optimizing acute gain, symmetry, and apposition of intracoronary stents in approximately 50% of patients. Moreover, ICUS guidance is associated with low rates for target vessel revascularization and major adverse cardiac events at 6-month follow-up.
支架置入术后高压球囊扩张已被证明可改善临床结局。然而，在支架置入过程中使用初始高压球囊扩张后，冠状动脉内超声（ICUS）是否能提供额外的临床指导尚不清楚。因此，本研究的目的是确定尽管高压球囊扩张已获得最佳血管造影结果，但ICUS成像是否能改善支架置入技术。
前瞻性收集了96例连续患者的数据，共置入151枚支架。通过视觉估计，支架和高压球囊在血管造影下尺寸为1:1。持续进行高压（所有病例均≥12个大气压）球囊扩张，直至血管造影完成（残余狭窄<10%），之后进行首次ICUS成像。评估支架贴壁、对称性和管腔尺寸。最佳ICUS结果定义为支架完全贴壁、对称率≥0.80且参考管腔面积的急性增益≥0.80。如果发现ICUS结果不理想，则使用更高压力或更大球囊进行进一步扩张，并随后用ICUS对支架进行重新评估。69枚（46%）支架需要额外的球囊扩张。在这些支架中，35枚（23%）初始急性增益小于参考管腔面积的80%。46枚（30%）支架发现有未贴壁的支架小梁，24枚（16%）对称率<0.80。在需要额外扩张的患者中，最小支架面积从7.6±2.2mm²增加到9.2±2.4mm²（P<.0001）。同样，完全支架贴壁情况从占总支架的33%改善到68%（P<.0001）。在首次ICUS检查后，40例患者进行了更高压力的扩张，33例患者使用了大于或等于ICUS参考血管直径的更大球囊。95例（99%）患者获得了随访。6个月时总的主要不良心脏事件发生率为9.3%，包括8例靶血管再血管化和1例需要重复干预的急性闭塞。
即使支架置入术后高压球囊扩张获得了最佳血管造影结果，ICUS仍可帮助约50%的患者优化冠状动脉支架的急性增益、对称性和贴壁情况。此外，在6个月随访时，ICUS指导与较低的靶血管再血管化率和主要不良心脏事件发生率相关。
