Meerkin D, Tardif J C, Bertrand O F, Vincent J, Harel F, Bonan R
Montreal Heart Institute, Quebec, Canada.
J Am Coll Cardiol. 2000 Jul;36(1):59-64. doi: 10.1016/s0735-1097(00)00678-1.
The aim of this study was to determine the natural history of postangioplasty intravascular ultrasound (IVUS)-detected dissections and to assess the influence of intracoronary beta-radiation on dissection resolution.
Intracoronary radiotherapy is considered to impair exaggerated vessel healing. Conversely, excessive healing impairment may increase the risk of complications due to unhealed dissection. Alternatively, residual dissection may represent an innocent marker of adequate therapy.
Immediate postangioplasty and six-month follow-up IVUS studies of 94 patients in the IVUS substudy of the MultiVitamins and Probucol (MVP) trial and 26 nonstented patients in the Beta Energy Restenosis Trial (BERT) were analyzed for the presence or absence of dissection.
Of the 28 patients with postangioplasty dissections in MVP, only one had evidence of residual dissection at six months (95% confidence interval [CI] for failure rate 0.2%; 20.2%). Conversely, 9 of 16 dissections had healed in BERT (95% CI for failure rate 30.6%; 79.2%) (p < 0.0002). Nevertheless, an index based on dissection arc and length demonstrated improvement in the irradiated patients. Irradiated patients with residual dissections showed significant increase in lumen area at six-months (5.10 +/- 0.98 to 7.11 +/- 2.61 mm2, p < 0.02) not noted when there was resolution of the dissection (6.03 +/- 2.38 to 6.36 +/- 3.33 mm2, p = NS). In both groups the external elastic membrane area was unchanged at follow-up.
Resolution appears to be the natural history of IVUS-detected dissections in most cases. Significant resolution of dissection occurs following intracoronary beta-radiation as reflected in reduced dissection index at six-months in these patients, although significant impairment of vessel wall healing was noted.
本研究旨在确定血管成形术后血管内超声（IVUS）检测到的夹层的自然病程，并评估冠状动脉内β射线照射对夹层消退的影响。
冠状动脉内放射治疗被认为会损害过度的血管愈合。相反，过度的愈合损害可能会增加未愈合夹层导致并发症的风险。另外，残余夹层可能是充分治疗的无害标志。
对多维生素与普罗布考（MVP）试验IVUS子研究中的94例患者以及β能量再狭窄试验（BERT）中的26例未置入支架患者进行血管成形术后即刻和6个月随访的IVUS研究，分析有无夹层。
在MVP中，28例血管成形术后出现夹层的患者中，只有1例在6个月时有残余夹层的证据（失败率的95%置信区间[CI]为0.2%；20.2%）。相反，在BERT中，16例夹层中有9例已愈合（失败率的95%CI为30.6%；79.2%）（p<0.0002）。然而，基于夹层弧度和长度的指数显示，接受照射的患者有改善。有残余夹层的照射患者在6个月时管腔面积显著增加（5.10±0.98至7.11±2.61mm²，p<0.02），而夹层消退时未观察到这种情况（6.03±2.38至6.36±3.33mm²，p=无显著性差异）。两组患者随访时外弹力膜面积均无变化。
在大多数情况下，消退似乎是IVUS检测到的夹层的自然病程。冠状动脉内β射线照射后夹层有显著消退，表现为这些患者6个月时夹层指数降低，尽管注意到血管壁愈合有显著损害。
