Department of Medical Engineering, Morinomiya Hospital, Osaka, Japan.
Cardiovascular Division, Morinomiya Hospital, 2-1-88 Morinomiya Joto-ku, Osaka, Osaka, 5360025, Japan.
Heart Vessels. 2022 Jun;37(6):961-968. doi: 10.1007/s00380-021-01994-w. Epub 2021 Nov 19.
Drug-coated balloon (DCB) is now available for endovascular treatment (EVT) of superficial femoral arteries (SFA). Although it has been reported that severe vessel dissection after balloon angioplasty was risk of restenosis, it is difficult to predict the vessel dissection patterns before balloon angioplasty. We investigated the correlation between plaque morphology and vessel dissection pattern after balloon angioplasty using the intravascular ultrasound (IVUS). A total of 73 de novo SFA lesions were enrolled in this study. IVUS examinations were measured at the minimum lumen area in the control angiogram. Plaque morphology, minimum lumen area (MLA) and vessel diameter at the same point were evaluated before and after the initial balloon angioplasty. Vessel dissection patterns after the initial balloon angioplasty were classified into 7 types (A to F). There were no severe dissection patterns which were more than type D dissection in this study. All patients were treated with DCB without any bailout stenting. No dissection was found in 35.6% (26/73). Type A, B and C dissections were seen in 17.8% (13/73), 40% (27/73) and 9.6% (7/73), respectively. Although there were no relations between plaque morphology and vessel dissection patterns (p = 0.547), the MLA with dissection was larger than that without dissection (5.78 mm versus 4.63 mm, p = 0.032). Although the dissection patterns could not be predicted in non-severe (Non or A to C) dissection, our result might suggest that IVUS image has the potential to reduce severe dissection.
药物涂层球囊（DCB）现已可用于治疗股浅动脉（SFA）的血管内治疗（EVT）。虽然据报道，球囊血管成形术后严重的血管夹层是再狭窄的风险因素，但在球囊血管成形术前很难预测血管夹层的模式。我们使用血管内超声（IVUS）研究了球囊血管成形术后斑块形态与血管夹层模式之间的相关性。这项研究共纳入了 73 例新发 SFA 病变。在对照血管造影中测量最小管腔面积（MLA）的 IVUS 检查。在初始球囊血管成形术前和术后评估斑块形态、最小管腔面积（MLA）和同一部位的血管直径。将初始球囊血管成形术后的血管夹层模式分为 7 种类型（A 至 F 型）。本研究中没有超过 D 型夹层的严重夹层模式。所有患者均接受 DCB 治疗，无一例 bailout 支架置入。无夹层 35.6%（26/73）。A型、B 型和 C 型夹层分别为 17.8%（13/73）、40%（27/73）和 9.6%（7/73）。尽管斑块形态与血管夹层模式之间无相关性（p=0.547），但有夹层的 MLA 大于无夹层的 MLA（5.78mm 比 4.63mm，p=0.032）。虽然在非严重（非或 A 至 C 型）夹层中无法预测夹层模式，但我们的结果可能表明 IVUS 图像有可能减少严重夹层。
