Marsico F, Kubica J, De Servi S, Angoli L, Bramucci E, Costante A M, Specchia G
Division of Cardiology, IRCCS S. Matteo Hospital, Pavia, Italy.
Br Heart J. 1995 Aug;74(2):134-9. doi: 10.1136/hrt.74.2.134.
To relate the mechanism of luminal gain after directional atherectomy and balloon angioplasty to the morphological characteristics of the coronary lesions, assessed by intravascular ultrasound imaging.
Intravascular ultrasound imaging was performed before and after the revascularisation procedure to assess the contribution of wall stretching and plaque reduction in luminal gain.
32 patients undergoing balloon angioplasty and 29 undergoing directional coronary atherectomy.
The main luminal area in vessels treated by balloon angioplasty increased from 1.51 (SD 0.30) to 3.91 (1.09) mm2 (P < 0.0001) with a concomitant increase in total vessel area from 11.44 (2.73) to 13.07 (2.83) mm2 (P < 0.0001). Therefore stretching of the vessel wall accounted for 68% of the luminal gain while plaque reduction accounted for the remaining 32%. This mechanism ranged from 45% in non-calcific plaques to 81% in echogenic plaques. The main luminal area in vessels treated by directional atherectomy increased from 1.49 (0.32) to 4.68 (1.73) mm2 (P < 0.0001), with a concomitant increase of total vessel area from 13.61 (4.67) to 15.2 (4.04) mm2 (P = 0.006). Thus stretching of the vessel wall accounted for 49% of the luminal area gain and plaque reduction for the remaining 51%. The presence of calcium influenced the relative contribution of these two mechanisms to the final luminal gain after directional atherectomy, since in calcific plaques stretching of the vessel wall accounted for only 9% of the luminal gain as compared to 56% in non-calcific plaques. After balloon angioplasty there was greater evidence of coronary dissections (32% v 3% after directional atherectomy, P < 0.01) and plaque fissure (60% v 0%, P < 0.01). Plaque fissure was more frequently seen in echolucent and concentric lesions, whereas dissections prevailed in echogenic and eccentric lesions.
Intravascular ultrasound imaging may allow the assessment of acute changes in lumen and vessel wall after revascularisation procedures, and help in evaluating the potential effect of the structure and morphology of coronary lesions on the mechanism of luminal enlargement.
通过血管内超声成像评估定向旋切术和球囊血管成形术后管腔增加的机制与冠状动脉病变形态学特征之间的关系。
在血运重建术前和术后进行血管内超声成像，以评估管壁伸展和斑块减少对管腔增加的作用。
32例行球囊血管成形术的患者和29例行定向冠状动脉旋切术的患者。
球囊血管成形术治疗的血管中，主要管腔面积从1.51（标准差0.30）增加到3.91（1.09）mm²（P<0.0001），同时血管总面积从11.44（2.73）增加到13.07（2.83）mm²（P<0.0001）。因此，血管壁伸展占管腔增加的68%，而斑块减少占其余的32%。这种机制在非钙化斑块中占45%，在回声斑块中占81%。定向旋切术治疗的血管中，主要管腔面积从1.49（0.32）增加到4.68（1.73）mm²（P<0.0001），同时血管总面积从13.61（4.67）增加到15.2（4.04）mm²（P=0.006）。因此，血管壁伸展占管腔面积增加的49%，斑块减少占其余的51%。钙化的存在影响了这两种机制对定向旋切术后最终管腔增加的相对作用，因为在钙化斑块中，血管壁伸展仅占管腔增加的9%，而非钙化斑块中为56%。球囊血管成形术后，冠状动脉夹层的证据更多（32%比定向旋切术后的3%，P<0.01），斑块破裂也更多（60%比0%，P<0.01）。斑块破裂在无回声和同心病变中更常见，而夹层在回声和偏心病变中更常见。
血管内超声成像可用于评估血运重建术后管腔和血管壁的急性变化，并有助于评估冠状动脉病变的结构和形态对管腔扩大机制的潜在影响。
