Jain S P, Jain A, Collins T J, Ramee S R, White C J
Department of Medicine, Ochsner Clinic, New Orleans, LA.
Am Heart J. 1994 Oct;128(4):664-73. doi: 10.1016/0002-8703(94)90262-3.
Despite advances in catheter-based interventional techniques, restenosis remains a major complication of angioplasty. Recently, intravascular ultrasound imaging (IVUS) has provided new insight into plaque composition and geometric distribution inside the vessel. To investigate if IVUS-defined parameters can predict restenosis in patients after coronary angioplasty, we performed IVUS in 33 patients (33 lesions) after balloon angioplasty (n = 25) or directional atherectomy (n = 8). Qualitative analysis included assessment of plaque composition, plaque eccentricity, plaque fracture, and presence of dissection. In addition, minimal luminal diameter, percent diameter stenosis, percent area stenosis, plaque burden, and elastic recoil were quantitatively analyzed. Follow-up data were obtained 1, 2, and 6 months after angioplasty and were available for 30 patients. Angiographic restenosis occurred in 11 patients (group 1), and no restenosis occurred in 19 patients (group 2) by clinical (n = 10) or angiographic (n = 9) assessment. Plaque fracture was noted in 30% of group 1 patients and 74% of group 2 patients (p = 0.04). Major dissections were more frequent in group I than in group II (78% vs 10%, p = 0.009). Of the quantitative parameters analyzed, plaque burden was significantly higher in group 1 than in group 2 (0.50 +/- 0.05 vs 0.34 +/- 0.05, p = 0.0001). In 78% of the patients with plaque burden of > 0.40, restenosis developed. Thus, of the various parameters analyzed, the absence of plaque fracture, the existence of a major dissection, and greater plaque burden were associated with increased incidence of restenosis. Our results indicate that IVUS can identify a subset of patients in whom restenosis is likely to develop. Information about the morphologic features of the atheroma and its composition may be used to modify the interventional strategy and thus optimize lumen size and possibly reduce the chance of restenosis.
尽管基于导管的介入技术取得了进展，但再狭窄仍然是血管成形术的主要并发症。最近，血管内超声成像（IVUS）为血管内斑块成分和几何分布提供了新的见解。为了研究IVUS定义的参数是否能够预测冠状动脉成形术后患者的再狭窄情况，我们对33例患者（33处病变）在球囊血管成形术（n = 25）或定向旋切术（n = 8）后进行了IVUS检查。定性分析包括对斑块成分、斑块偏心性、斑块破裂和夹层情况的评估。此外，还对最小管腔直径、直径狭窄百分比、面积狭窄百分比、斑块负荷和弹性回缩进行了定量分析。血管成形术后1、2和6个月获得随访数据，30例患者有可用数据。经临床（n = 10）或血管造影（n = 9）评估，11例患者（第1组）发生血管造影再狭窄，19例患者（第2组）未发生再狭窄。第1组30%的患者和第2组74%的患者出现斑块破裂（p = 0.04）。第I组的主要夹层比第II组更常见（78%对10%，p = 0.009）。在分析的定量参数中，第1组的斑块负荷显著高于第2组（0.50±0.05对0.34±0.05，p = 0.0001）。在斑块负荷> 0.40的患者中，78%发生了再狭窄。因此，在分析的各种参数中，无斑块破裂、存在主要夹层和更大的斑块负荷与再狭窄发生率增加相关。我们的结果表明，IVUS能够识别可能发生再狭窄的患者亚组。关于动脉粥样硬化形态特征及其成分的信息可用于调整介入策略，从而优化管腔大小并可能降低再狭窄的几率。
