Nara Nishinokyo Vascular Institute, Department of Cardiovascular Medicine, Nishinokyo Hospital, Nara-city, Nara, Japan.
Catheter Cardiovasc Interv. 2013 Mar;81(4):E199-205. doi: 10.1002/ccd.24509. Epub 2012 Nov 14.
To elucidate the optimal cutoff and accuracy of duplex ultrasonography (DUS) parameters for in-stent restenosis (ISR) after nitinol stenting in the superficial femoral artery (SFA).
Few data are available regarding the performance of DUS for binary ISR based on quantitative vessel analysis (QVA) in the era of SFA nitinol stenting.
This retrospective study included 74 in-stent stenoses of SFA who underwent DUS before follow-up angiography. DUS parameters, such as peak systolic velocity (PSV) and the peak systolic velocity ratio (PSVR), were compared with percent diameter stenosis (%DS) from a QVA basis.
There was a statistically significant correlation (P < 0.001) between "%DS and PSV" and "%DS and PSVR," and the correlation with %DS proved to be stronger in PSVR (R = 0.720) than in PSV (R = 0.672). The best performing parameter for ISR (50% or greater stenosis) was revealed PSVR, as the areas under the receiver operator characteristics curves using PSVR and PSV were 0.908 and 0.832, respectively. A PSVR cut off value of 2.85 yielded the best predictive value with sensitivity of 88%, specificity of 84%, and accuracy of 86%. The positive predictive value was 85% and the negative predictive value was 88%.
A PSVR of 2.85 is the optimal threshold for ISR after nitinol stenting in the SFA. Further large prospective studies are required for the validation and establishment of uniform criteria for DUS parameters.
阐明在股浅动脉（SFA）应用镍钛诺支架治疗后，通过双功能超声（DUS）检测支架内再狭窄（ISR）的最佳截断值和准确性。
关于在 SFA 镍钛诺支架时代基于定量血管分析（QVA）的 DUS 对二进制 ISR 的性能，可用数据很少。
本回顾性研究纳入了 74 例 SFA 支架内狭窄患者，他们在随访血管造影前接受了 DUS 检查。比较了 DUS 参数，如收缩期峰值速度（PSV）和收缩期峰值速度比（PSVR）与 QVA 基础上的直径狭窄百分比（%DS）。
%DS 和 PSV 之间以及%DS 和 PSVR 之间存在统计学显著相关性（P<0.001），PSVR 与%DS 的相关性比 PSV（R=0.720 比 R=0.672）更强。对于 ISR（狭窄程度为 50%或更高），表现最佳的参数是 PSVR，因为 PSVR 和 PSV 的受试者工作特征曲线下面积分别为 0.908 和 0.832。PSVR 截断值为 2.85 时具有最佳预测值，其敏感性为 88%，特异性为 84%，准确性为 86%。阳性预测值为 85%，阴性预测值为 88%。
PSVR 为 2.85 是 SFA 中镍钛诺支架治疗后 ISR 的最佳阈值。需要进一步进行大型前瞻性研究，以验证和建立 DUS 参数的统一标准。
