Shammas Nicolas W, Torey James T, Shammas W John, Jones-Miller Susan, Shammas Gail A
Midwest Cardiovascular Research Foundation, 1622 E. Lombard Street, Davenport, IA 52803 USA.
J Invasive Cardiol. 2018 Jul;30(7):240-244.
Dissections occur post atherectomy of the infrainguinal arteries. We hypothesized that angiography under-estimates their presence significantly.
In this prospective pilot study, a total of 15 patients were evaluated by intravascular ultrasound (IVUS) following treatment of femoropopliteal de novo or non-stent restenosis using atherectomy. Eagle Eye Platinum ST IVUS catheters (Philips) were used in this study. Thirteen Jetstream XC atherectomy devices (Boston Scientific) and 2 investigational B-laser atherectomy devices (Eximo Medical) were used. Cine and IVUS images were obtained at baseline, after atherectomy, and after adjunctive balloon angioplasty. Angiographic and IVUS core labs analyzed the images.
Mean age was 70.6 ± 8.0 years. Diabetes and claudication were present in 60% and 73%, respectively. Mean baseline, post-atherectomy, and post-adjunctive angioplasty stenosis severity was 71.4%, 38.1%, and 19.7%, respectively (P<.001 for both baseline vs post atherectomy and post atherectomy vs adjunctive angioplasty). Lesion length was 108.5 ± 43.1 mm. Forty-six dissections were identified on IVUS post atherectomy vs 8 dissections on angiogram (P<.01) (ratio, 5.75 to 1). Post adjunctive angioplasty, there were 39 dissections on IVUS vs 11 on angiogram (P<.01) (ratio, 3.55 to 1). Of these dissections, 13% and 30.8% were ≥180° in circumference post atherectomy and adjunctive balloon angioplasty, respectively (P=.047). Also, 39.1% and 33.3% involved the media and/or adventitia as seen on IVUS post atherectomy and adjunctive balloon angioplasty, respectively (P=.58). Longer lesions correlated with more dissections post atherectomy on IVUS (P=.03), but not on angiogram (P=.28).
Dissections post atherectomy are grossly under-appreciated on angiogram when compared to IVUS. A multicenter registry correlating these findings with clinical outcomes is needed.
股腘动脉旋切术后会出现夹层。我们推测血管造影术会显著低估夹层的存在。
在这项前瞻性试点研究中，共有15例患者在使用旋切术治疗股腘动脉初发或非支架再狭窄后接受了血管内超声（IVUS）评估。本研究使用了鹰眼铂金ST IVUS导管（飞利浦公司）。使用了13个Jetstream XC旋切装置（波士顿科学公司）和2个研究用B型激光旋切装置（Eximo Medical公司）。在基线、旋切术后以及辅助球囊血管成形术后获取了电影血管造影和IVUS图像。血管造影和IVUS核心实验室对图像进行了分析。
平均年龄为70.6±8.0岁。糖尿病和间歇性跛行的发生率分别为60%和73%。平均基线、旋切术后以及辅助血管成形术后的狭窄严重程度分别为71.4%、38.1%和19.7%（基线与旋切术后以及旋切术后与辅助血管成形术后相比，P均<0.001）。病变长度为108.5±43.1毫米。旋切术后IVUS发现46处夹层，而血管造影发现8处夹层（P<0.01）（比例为5.75比1）。辅助球囊血管成形术后，IVUS发现39处夹层，血管造影发现11处夹层（P<0.01）（比例为3.55比1）。在这些夹层中，旋切术后和辅助球囊血管成形术后分别有13%和30.8%的夹层圆周≥180°（P=0.047）。此外，旋切术后和辅助球囊血管成形术后IVUS显示分别有39.1%和33.3%的夹层累及中膜和/或外膜（P=0.58）。较长的病变与旋切术后IVUS发现的更多夹层相关（P=0.03），但与血管造影结果无关（P=0.28）。
与IVUS相比，血管造影严重低估了旋切术后夹层的情况。需要一个多中心登记研究将这些发现与临床结果相关联。
