Okura Hiroyuki, Shimodozono Shinichi, Hayase Motoya, Bonneau Heidi N, Yock Paul G, Fitzgerald Peter J
Center for Research in Cardiovascular Interventions, Stanford University Medical Center, Stanford, Calif 94305-5637, USA.
Am Heart J. 2002 Aug;144(2):323-8. doi: 10.1067/mhj.2002.122282.
Arterial remodeling has been shown to be responsible for lumen narrowing after nonstent interventions.
To examine the impact of deep vessel wall injury (DI) after balloon angioplasty on the subsequent vessel remodeling process, we performed serial intravascular ultrasound (IVUS) analysis in 47 native coronary artery lesions that underwent balloon angioplasty. An IVUS study was performed before and after balloon angioplasty and repeated at follow-up. Vessel and lumen area were measured at the narrowest site before intervention. Plaque area was calculated as vessel area minus lumen area. DI was defined as the presence of plaque/vessel wall fracture deep in the medial layer (sonolucent zone by IVUS) after angioplasty.
After angioplasty, DI was present in 18 (38%, DI group) and absent in 29 (62%, non-DI group) of lesions. During follow-up, changes in vessel area in the DI group were significantly larger than in the non-DI group (P =.007). There were no significant differences in changes in plaque area. A trend toward greater late lumen loss was observed in the non-DI group (P =.05). In the DI group, changes in lumen area correlated better with changes in vessel area (r = 0.81, P <.0001) than with changes in plaque area (r = 0.32, P =.20). However, in the non-DI group, changes in lumen area correlated with changes in plaque area (r = -0.55, P =.002), but not with changes in vessel area (r = 0.30, P =.11).
Deep vessel wall injury after balloon angioplasty is associated with the magnitude of the subsequent vessel remodeling process. The differences in the remodeling process may have implications regarding adjunctive therapies to prevent restenosis after balloon angioplasty.
动脉重塑已被证明是导致非支架介入治疗后管腔狭窄的原因。
为了研究球囊血管成形术后深部血管壁损伤（DI）对后续血管重塑过程的影响，我们对47例接受球囊血管成形术的原发性冠状动脉病变进行了系列血管内超声（IVUS）分析。在球囊血管成形术前和术后进行IVUS研究，并在随访时重复进行。在干预前测量最狭窄部位的血管和管腔面积。斑块面积通过血管面积减去管腔面积计算得出。DI定义为血管成形术后中层深部存在斑块/血管壁破裂（IVUS显示为无回声区）。
血管成形术后，18例病变（38%，DI组）存在DI，29例病变（62%，非DI组）不存在DI。在随访期间，DI组血管面积的变化显著大于非DI组（P = 0.007）。斑块面积的变化无显著差异。非DI组观察到晚期管腔丢失增加的趋势（P = 0.05）。在DI组中，管腔面积的变化与血管面积的变化相关性更好（r = 0.81，P < 0.0001），而与斑块面积的变化相关性较差（r = 0.32，P = 0.20）。然而，在非DI组中，管腔面积的变化与斑块面积的变化相关（r = -0.55，P = 0.002），但与血管面积的变化无关（r = 0.30，P = 0.11）。
球囊血管成形术后深部血管壁损伤与随后血管重塑过程的程度相关。重塑过程的差异可能对预防球囊血管成形术后再狭窄的辅助治疗有影响。
