Casserly Ivan P, Aronow Herbert D, Schoenhagen Paul, Tsutsui Hiroshi, Popovich Jennifer, Goormastic Marlene, Popma Jeffrey J, Nissen Steven E, Tuzcu E Murat
Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
J Am Coll Cardiol. 2002 Nov 6;40(9):1573-8. doi: 10.1016/s0735-1097(02)02341-0.
The objective of this study was to examine the relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and neointimal growth after coronary stenting.
Previous intravascular ultrasound (IVUS) studies have demonstrated a correlation between residual atheroma burden and neointimal growth after coronary stenting. However, postmortem studies contradict this finding.
The study population included 34 patients who underwent IVUS six to eight months after stent placement, including 26 patients who underwent IVUS immediately after stent placement and at six to eight months follow-up. Using manual planimetry, the lumen cross-sectional area (LA), stent cross-sectional area (SA) and external elastic membrane cross-sectional area (EEM) were measured at 1-mm intervals after the procedure and at follow-up. Percent neointimal area (NA) and atheroma area (AA) were calculated as: percent neointimal area = ([SA - LA]/SA) x 100; percent AA = ([EEM - SA]/EEM) x 100 in the entire cross section and in individual quadrants. Postinterventional atheroma volume and neointimal volume at follow-up were calculated using Simpsons's rule.
In pooled analyses using all cross sections and cross-sectional quadrants, there was a weak correlation between percent AA and NA (r = 0.11 and 0.12, respectively). Analysis in individual patients demonstrated no significant relationship between total or quadrant measurements of percent AA and NA (p = 0.47 and 0.4, respectively). No relationship between atheroma volume postintervention and neointimal volume at follow-up was observed (r = 0.1, p = 0.62).
This study failed to demonstrate a clinically significant relationship between quantitative volumetric and cross-sectional measures of residual atheroma burden and subsequent neointimal growth.
本研究旨在探讨冠状动脉支架置入术后残余动脉粥样硬化负荷的定量容积测量与横截面积测量以及新生内膜生长之间的关系。
先前的血管内超声（IVUS）研究已证实冠状动脉支架置入术后残余动脉粥样硬化负荷与新生内膜生长之间存在相关性。然而，尸检研究与这一发现相矛盾。
研究人群包括34例在支架置入后6至8个月接受IVUS检查的患者，其中26例在支架置入后立即及6至8个月随访时接受了IVUS检查。使用手工面积测量法，在术后及随访时每隔1毫米测量管腔横截面积（LA）、支架横截面积（SA）和外弹力膜横截面积（EEM）。计算整个横截面及各个象限的新生内膜面积百分比（NA）和动脉粥样硬化面积百分比（AA），计算公式为：新生内膜面积百分比 = （[SA - LA]/SA）×100；动脉粥样硬化面积百分比 = （[EEM - SA]/EEM）×100。随访时使用辛普森法则计算介入治疗后动脉粥样硬化体积和新生内膜体积。
在对所有横截面和横截面象限进行的汇总分析中，AA百分比与NA百分比之间存在弱相关性（分别为r = 0.11和0.12）。个体患者分析显示，AA百分比的总和或象限测量值与NA百分比之间无显著关系（p分别为0.47和0.4）。未观察到介入治疗后动脉粥样硬化体积与随访时新生内膜体积之间的关系（r = 0.1，p = 0.62）。
本研究未能证明残余动脉粥样硬化负荷的定量容积测量与横截面积测量以及随后的新生内膜生长之间存在具有临床意义的关系。
