Nakamura Mamoo, Yock Paul G, Kataoka Toru, Bonneau Heidi N, Suzuki Takahiko, Yamaguchi Tetsu, Honda Yasuhiro, Fitzgerald Peter J
Center for Research in Cardiovascular Interventions, Stanford University, Stanford, California 94305-5637, USA.
Am J Cardiol. 2003 Jan 1;91(1):6-11. doi: 10.1016/s0002-9149(02)02989-2.
Deep vessel wall injury is believed to affect vessel dimension following coronary intervention. The cutting balloon is designed to treat coronary artery stenoses with dilatation and surgical incisions, thereby reducing excess vessel injury. This study examines the effect of deep vessel wall injury on acute and late coronary arterial response after cutting balloon angioplasty. Serial volumetric intravascular ultrasound (IVUS) analyses were performed in 63 lesions treated with cutting balloon angioplasty alone. Before intervention, the longitudinal range of the lesion segment that included the smallest lumen area (LA) was determined as LA <4 mm(2) and/or LA stenosis >60%. The exact corresponding site at postintervention and follow-up was aligned using peri- and intravascular landmarks. Average vessel area (VA), plaque area (PA), and LA were measured. Lesion segments were categorized as with or without deep vessel wall injury, which was defined as the presence of plaque/vessel wall fracture extending to the sonolucent (medial) layer. Before intervention, the lesion vessel size of deep injury group was smaller than that of the nondeep injury group (p <0.05 for average VA and PA), whereas average lesion LA, lesion length, and reference vessel size did not differ. Immediately after cutting balloon angioplasty, the deep injury group showed a significant increase in VA (p <0.0001) and a lesser decrease in PA (p <0.01) compared with the nondeep injury group. During follow-up, the increase of VA tended to be greater in the deep injury group than in the nondeep injury group (p = 0.06), whereas the change of PA did not differ. Consequently, LA decrease was less in the deep injury group than in the nondeep injury group (p <0.05). From these results, it is suggested that deep vessel wall injury tends to occur in lesions with relatively small size and such lesions show favorable vessel response after cutting balloon angioplasty.
人们认为，深度血管壁损伤会影响冠状动脉介入术后的血管尺寸。切割球囊旨在通过扩张和手术切口治疗冠状动脉狭窄，从而减少过度的血管损伤。本研究探讨深度血管壁损伤对切割球囊血管成形术后急性和晚期冠状动脉反应的影响。对63例仅接受切割球囊血管成形术治疗的病变进行了系列血管内超声（IVUS）容积分析。干预前，将包含最小管腔面积（LA）的病变节段的纵向范围确定为LA<4 mm²和/或LA狭窄>60%。使用血管周围和血管内标志对齐干预后和随访时的确切对应部位。测量平均血管面积（VA）、斑块面积（PA）和LA。病变节段分为有或无深度血管壁损伤，深度血管壁损伤定义为存在延伸至无回声（中层）层的斑块/血管壁破裂。干预前，深度损伤组的病变血管尺寸小于非深度损伤组（平均VA和PA，p<0.05），而平均病变LA、病变长度和参考血管尺寸无差异。与非深度损伤组相比，切割球囊血管成形术后立即，深度损伤组的VA显著增加（p<0.0001），PA减少较少（p<0.01）。随访期间，深度损伤组的VA增加趋势大于非深度损伤组（p=0.06），而PA的变化无差异。因此，深度损伤组的LA减少小于非深度损伤组（p<0.05）。从这些结果来看，提示深度血管壁损伤倾向于发生在相对较小尺寸的病变中，并且此类病变在切割球囊血管成形术后显示出良好的血管反应。
