Miki Kojiro, Fujii Kenichi, Fukunaga Masashi, Nishimura Machiko, Horimatsu Tetsuo, Saita Ten, Tamaru Hiroto, Imanaka Takahiro, Shibuya Masahiko, Naito Yoshiro, Masuyama Tohru
Cardiovascular Division, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 6638501, Japan.
Heart Vessels. 2016 Apr;31(4):519-27. doi: 10.1007/s00380-014-0625-1. Epub 2015 Jan 21.
Although intravascular ultrasound (IVUS) predictors of stent patency for the coronary artery lesion have been established, little is known about IVUS predictors of stent patency for the aorto-iliac artery lesion. We analyzed 154 lesions of 122 patients who underwent stent implantation for iliac artery lesions. Quantitative and qualitative IVUS analyses were performed for pre- and post-procedural IVUS imaging in all lesions. Target lesion revascularization (TLR) was defined as clinically driven revascularization with >50 % angiographic stenosis of the target lesion. The mean follow-up period was 39 ± 16 months. TLRs were performed in 13 lesions (8.4 %). Post-procedural minimum stent area (MSA) was significantly smaller in the TLR group compared to the no-TLR group (16.0 ± 5.8 vs. 25.6 ± 8.5 mm(2), p < 0.001). Stent edge dissection was frequently observed in the TLR group compared to the no-TLR group (53.8 vs. 24.1 %, p = 0.04). Multivariate analysis revealed that post-procedural MSA (OR = 0.76, p < 0.01) and stent edge dissection (OR = 10.4, p < 0.01) were independent IVUS predictors of TLR. Receiver-operating characteristic analysis identified post-procedural MSA <17.8 mm(2) as the optimal cut-point for the prediction of TLR (AUC = 0.846). Post-procedural MSA and stent edge dissection could predict long-term stent patency in the iliac artery lesion. Our results propose that adequate stent enlargement without edge dissection might be important to reduce TLR in the iliac artery lesion.
尽管已经确定了冠状动脉病变支架通畅性的血管内超声（IVUS）预测指标，但对于主-髂动脉病变支架通畅性的IVUS预测指标却知之甚少。我们分析了122例因髂动脉病变接受支架植入患者的154处病变。对所有病变术前和术后的IVUS图像进行了定量和定性分析。靶病变血运重建（TLR）定义为因临床需要对靶病变进行血管造影显示狭窄>50%的血运重建。平均随访期为39±16个月。13处病变（8.4%）进行了TLR。与无TLR组相比，TLR组术后最小支架面积（MSA）明显更小（16.0±5.8 vs. 25.6±8.5 mm²，p<0.001）。与无TLR组相比，TLR组更常观察到支架边缘夹层（53.8% vs. 24.1%，p = 0.04）。多变量分析显示，术后MSA（OR = 0.76，p<0.01）和支架边缘夹层（OR = 10.4，p<0.01）是TLR的独立IVUS预测指标。受试者工作特征分析确定术后MSA<17.8 mm²为预测TLR的最佳切点（AUC = 0.846）。术后MSA和支架边缘夹层可预测髂动脉病变支架的长期通畅性。我们的结果表明，在不发生边缘夹层的情况下充分扩大支架对减少髂动脉病变的TLR可能很重要。
