Pinto F J, St Goar F G, Gao S Z, Chenzbraun A, Fischell T A, Alderman E L, Schroeder J S, Popp R L
Division of Cardiovascular Medicine, Stanford University School of Medicine, CA 94305.
Circulation. 1993 Oct;88(4 Pt 1):1709-14. doi: 10.1161/01.cir.88.4.1709.
Intracoronary ultrasound (ICUS) has the ability to quantitatively evaluate vessel wall morphology and is well suited for serial studies of coronary artery disease regression and progression. However, the potential risk for catheter-induced endothelial damage and accelerated atherosclerosis in instrumented vessels is a concern. The acute effects as well as the 1-year safety of ICUS regarding its impact on the atherosclerotic process were assessed.
The acute studies include 240 intracoronary studies performed in 170 cardiac transplant recipients. Patients were systematically heparinized. Only vessels > or = 2 mm in diameter were visualized. Coronary arteries of 38 patients were measured by quantitative coronary angiography in matched angiograms at an interval of 1 year after the initial ICUS examination was performed to assess long-term effects. The angiographic measurements in the previously instrumented and noninstrumented vessels were compared. Forty-nine vessels that had been imaged (IM) in these 38 patients with a 5F ICUS catheter were compared with 61 vessels not previously imaged (NIM) in the same patients. Absolute and percentage change in angiographically measured mean vessel diameters in the ICUS imaged and nonimaged segments were compared. Despite pretreatment with nitroglycerin, 20 patients (8.3%) had angiographically evident coronary spasm. In all cases, this was reversed by giving nitroglycerin. One year after the original imaging study, no difference was noted between imaged and nonimaged vessels in change in absolute vessel diameter (IM, -0.11 +/- 0.28 mm vs NIM, -0.07 +/- 0.22 mm; P = .49) or in percentage change in diameter (IM, -5 +/- 11% vs NIM, -3 +/- 7%; P = .32).
Intracoronary ultrasound in cardiac transplant recipients was associated with no clinical morbidity and a low incidence of vessel spasm in large and medium-size coronary arteries. It does not accelerate progression of angiographically quantifiable coronary artery disease. This study suggests that ICUS can be safely used even in coronary arteries not undergoing interventions.
冠状动脉内超声（ICUS）能够定量评估血管壁形态，非常适合用于冠状动脉疾病消退和进展的系列研究。然而，导管引起的内皮损伤以及仪器化血管中动脉粥样硬化加速的潜在风险令人担忧。我们评估了ICUS对动脉粥样硬化进程的急性影响以及1年安全性。
急性研究包括对170例心脏移植受者进行的240次冠状动脉内检查。患者系统性接受肝素治疗。仅对直径≥2mm的血管进行成像。在最初的ICUS检查后1年，对38例患者的冠状动脉进行定量冠状动脉造影测量，通过匹配的血管造影图像评估长期影响。比较先前进行仪器检查和未进行仪器检查的血管的血管造影测量结果。将这38例患者中使用5F ICUS导管成像的49条血管（IM）与同一患者中先前未成像的61条血管（NIM）进行比较。比较ICUS成像和未成像节段血管造影测量的平均血管直径的绝对值和百分比变化。尽管使用硝酸甘油进行预处理，仍有20例患者（8.3%）出现血管造影可见的冠状动脉痉挛。在所有病例中，给予硝酸甘油后痉挛均得到缓解。在最初成像研究1年后，成像和未成像血管在绝对血管直径变化方面（IM，-0.11±0.28mm vs NIM，-0.07±0.22mm；P = 0.49）或直径百分比变化方面（IM，-5±11% vs NIM，-3±7%；P = 0.32）均未发现差异。
心脏移植受者的冠状动脉内超声与无临床发病率以及大中型冠状动脉中血管痉挛的低发生率相关。它不会加速血管造影可量化的冠状动脉疾病的进展。这项研究表明，即使在未进行干预的冠状动脉中，ICUS也可安全使用。
