Inglese L, Fantoni C, Sardana V
Department of Interventional Cardiovascular Radiology, IRCCS, San Donato Policlinic, San Donato Milanese, Milan, Italy.
J Cardiovasc Surg (Torino). 2009 Dec;50(6):735-44.
Several previous studies focusing on comparison between outcomes of carotid artery stenting (CAS) and carotid endoarterectomy (CEA) have put forward conflicting results about the non-inferiority of CAS compared to CEA. Likely outcomes after CAS have been greatly limited by incomplete knowledge of atherosclerotic carotid pathology and probably inappropriate patient selection criteria. In the current practice, only the degree of lumen obstruction is indication to an invasive treatment (CEA or CAS) in symptomatic or asymptomatic patients, but it has been recently demonstrated that histology of carotid plaques also plays a major role. Indeed, plaque morphology and composition seem to influence more importantly outcomes of CAS than those of CEA. Angiography is a poor diagnostic tool to detect the severity and composition of atherosclerotic lesions. Virtual histology (VH) is a new technology incorporated in the latest intravascular ultrasound (IVUS) equipment that allows a validated histological characterization of plaques by performing a spectral, objective and highly-reproducible analysis of the radiofrequency and amplitude data of the ultrasound waves that cross different tissues. This manuscript reports authors' experience with the use of IVUS-VH during CAS. This new technology, by characterizing morphology, extension and histology of carotid plaque, seems to provide important information for confirming percentage of carotid stenosis and judging its embolic potential, tailoring the procedure and guiding the choice of stent and finally for checking stent apposition and complete covering of vulnerable plaques. According to authors' opinion IVUS-VH has the potential to optimize patients' and lesions' selection criteria for CAS in order to improve its outcomes.
先前有几项研究聚焦于比较颈动脉支架置入术（CAS）和颈动脉内膜切除术（CEA）的疗效，然而关于CAS相对于CEA的非劣效性，研究结果相互矛盾。由于对动脉粥样硬化性颈动脉病变的认识不全面以及患者选择标准可能不恰当，CAS术后的可能疗效受到了极大限制。在当前的临床实践中，对于有症状或无症状患者，仅管腔阻塞程度是侵入性治疗（CEA或CAS）的指征，但最近有研究表明，颈动脉斑块的组织学特征也起着重要作用。事实上，斑块的形态和成分似乎对CAS疗效的影响比CEA更为显著。血管造影对于检测动脉粥样硬化病变的严重程度和成分而言，是一种较差的诊断工具。虚拟组织学（VH）是一项纳入最新血管内超声（IVUS）设备的新技术，它通过对穿过不同组织的超声波的射频和振幅数据进行光谱分析、客观分析和高度可重复分析，从而实现对斑块进行有效的组织学特征描述。本文报告了作者在CAS过程中使用IVUS-VH的经验。这项新技术通过对颈动脉斑块的形态、范围和组织学特征进行描述，似乎为确认颈动脉狭窄百分比、判断其栓塞潜能、调整手术方案、指导支架选择以及最终检查支架贴壁情况和对易损斑块的完全覆盖提供了重要信息。作者认为，IVUS-VH有潜力优化CAS患者和病变的选择标准，以改善其疗效。
