Takimura Hideyuki, Hirano Keisuke, Muramatsu Toshiya, Tsukahara Reiko, Ito Yoshiaki, Sakai Tsuyoshi, Ishimori Hiroshi, Nakano Masatsugu, Yamawaki Masahiro, Araki Motoharu, Kato Tamon, Kobayashi Norihiro, Sakamoto Yasunari, Ishii Ai, Takama Takuro, Tokuda Takahiro
Department of Cardiology, Saiseikai Yokohama City Eastern Hospital, Yokohama, Japan.
J Endovasc Ther. 2014 Oct;21(5):654-61. doi: 10.1583/13-4487MR.1.
To examine the effectiveness of vascular elastography (VE) for the assessment of totally occluded lower limb arteries prior to endovascular treatment (EVT).
Of 812 consecutive patients who underwent EVT between April 2010 and April 2012, VE was used to evaluate the hardness of chronic total occlusions of the femoropopliteal segment prior to EVT in 65 consecutive patients (48 men; mean 73.9 years, range 63-86). Elastograms of the CTOs proximally and distally were scored using a 5-point scale, and outcomes in limbs with hard lesions (VE score 0-2) were compared to those with soft lesions (VE score 3-4) according to lesion length. The interventionists who performed the endovascular procedures were not informed of the VE score results.
CTO characteristics could be evaluated in all cases. A VE score ≤2 was found in 14 of the 23 lesions <150 mm in length. A flexible guidewire was sufficient for recanalization in more of the soft lesions than in the hard lesions [6/9 vs. 2/14, respectively]. In 39 lesions >150 mm, a VE score of 3 was recorded in most lesions proximally, while lesions distally were hard in many cases (VE score 1 or 2). A flexible guidewire alone was sufficient in many soft CTOs (8/13, p<0.01). In 16 cases, hard calcified plaque was indicated by difficulty in penetrating the lesion even with a stiff guidewire; all these cases had a VE score of 1 or 2. A retrograde approach was required only in hard CTOs (p<0.01). The procedure time was significantly longer for the hard lesion group (152.9±63.2 vs. 87.0±29.8 minutes, p=0.001). In 11 in-stent occlusions, only VE scores of 3 (n=4) or 4 (n=7) were recorded, indicating soft thrombus, which was aspirated under distal protection in 7 cases.
VE may be a useful method for determining the hardness of CTO lesions noninvasively before endovascular therapy, providing information that can help plan the procedure.
探讨血管弹性成像（VE）在血管内治疗（EVT）前评估下肢完全闭塞动脉的有效性。
在2010年4月至2012年4月期间连续接受EVT的812例患者中，对65例连续患者（48例男性；平均73.9岁，范围63 - 86岁）在EVT前使用VE评估股腘段慢性完全闭塞的硬度。使用5分制对CTO近端和远端的弹性成像进行评分，并根据病变长度将硬病变（VE评分0 - 2）肢体的结果与软病变（VE评分3 - 4）肢体的结果进行比较。进行血管内手术的介入医生未被告知VE评分结果。
所有病例均可评估CTO特征。在23例长度<150 mm的病变中，14例VE评分≤2。与硬病变相比，软病变中使用柔性导丝进行再通更充分[分别为6/9和2/14]。在39例长度>150 mm的病变中，大多数病变近端的VE评分为3，而许多病变远端较硬（VE评分1或2）。在许多软CTO中单独使用柔性导丝就足够了（8/13，p<0.01）。在16例病例中，即使使用硬导丝穿透病变也困难，提示存在硬钙化斑块；所有这些病例的VE评分为1或2。仅在硬CTO中需要逆行入路（p<0.01）。硬病变组的手术时间明显更长（152.9±63.2对87.0±29.8分钟，p = 0.001）。在11例支架内闭塞中，仅记录到VE评分为3（n = 4）或4（n = 7），提示为软血栓，其中7例在远端保护下进行了抽吸。
VE可能是在血管内治疗前无创确定CTO病变硬度的有用方法，可为手术规划提供信息。
