Kuku Kayode O, Garcia-Garcia Hector M, Koifman Edward, Kajita Alexandre H, Desale Sameer, Azizi Viana, Melaku Gebremedhin, Bui Anh, Meirovich Yael F, Beyene Solomon, Dheendsa Aaphtaab, Schneider Blaine, Waksman Ron
MedStar Cardiovascular Research Network, MedStar Washington Hospital Center, Washington, DC, USA.
Division of Interventional Cardiology, MedStar Washington Hospital Center, 110 Irving Street NW, Washington, DC, 20010, USA.
Int J Cardiovasc Imaging. 2018 Mar;34(3):345-352. doi: 10.1007/s10554-017-1248-2. Epub 2017 Sep 26.
The CliRpath Excimer Laser System to Enlarge Lumen Openings (CELLO) registry included patients treated with modified excimer laser catheters for the endovascular treatment of peripheral artery disease affecting the superficial femoral artery (SFA) and proximal popliteal artery. The aim of this study was to assess, via intravascular ultrasound (IVUS) the dissections in the vessel wall following treatment with the laser catheters. IVUS grayscale images from the CELLO registry were systematically reviewed for dissections in the treated vessel segments by two investigators. Images from 33 patients; 66 pullbacks (1867 IVUS frames in 2 phases), were successfully matched frame-to-frame to evaluate identical segments of the treated vessels in the two phases; post-2 mm Turbo-Elite laser pilot channel creation and post Turbo-Booster laser atherectomy. Dissections were categorized as; (1) intimal, (2) medial, (3) intramural hematoma, and (4) adventitial according to the ACC Clinical Expert Consensus Document classification of dissections. An average of 57 frames was evaluated per pullback, giving a total of 3734 frames (1867 matched for pre-ablation (post channel creation) and post-ablation phases). Treatments with the modified Excimer laser catheters resulted in a significant increase in lumen area of 5.5 ± 3.2-mm (95% CI 4.3-6.8, p < 0.0001) and reduction in plaque plus media volume of -10.6 ± 36.0 mm (95% CI -25.8 to 4.6, p = 0.1619) whilst giving rise to mainly intramural hematoma formations post Turbo-Booster laser treatment in 55% of frames assessed and 24% medial dissections with less than 1% adventitial disruption. The Excimer laser based Turbo-Booster treatment of peripheral artery lesions resulted in significant plaque debulking and increased lumen diameter with negligible degree of adventitial layer injury.
用于扩大管腔开口的CliRpath准分子激光系统（CELLO）注册研究纳入了使用改良准分子激光导管进行血管内治疗的患者，这些患者患有影响股浅动脉（SFA）和腘动脉近端的外周动脉疾病。本研究的目的是通过血管内超声（IVUS）评估激光导管治疗后血管壁的夹层情况。两名研究人员对CELLO注册研究中的IVUS灰度图像进行系统回顾，以查找治疗血管段中的夹层。来自33例患者的图像；66次回撤（分两个阶段共1867个IVUS帧），成功逐帧匹配，以评估两个阶段中治疗血管的相同节段；2毫米Turbo-Elite激光引导通道创建后以及Turbo-Booster激光斑块旋切术后。夹层分类如下：（1）内膜夹层，（2）中膜夹层，（3）壁内血肿，（4）外膜夹层，依据美国心脏病学会（ACC）夹层临床专家共识文件分类。每次回撤平均评估57帧，共评估3734帧（1867帧在消融前（通道创建后）和消融后阶段匹配）。使用改良准分子激光导管治疗使管腔面积显著增加5.5±3.2平方毫米（95%置信区间4.3 - 6.8，p<0.0001），斑块加中膜体积减少-10.6±36.0立方毫米（95%置信区间-25.8至4.6，p = 0.1619），同时在评估的55%的帧中，Turbo-Booster激光治疗后主要形成壁内血肿，24%为中膜夹层，外膜破裂少于1%。基于准分子激光的Turbo-Booster治疗外周动脉病变导致斑块显著减容，管腔直径增加，外膜层损伤程度可忽略不计。
