White C J, Ramee S R, Collins T J, Mesa J E, Jain A
Department of Internal Medicine, Ochsner Clinic, New Orleans, Louisiana.
J Am Coll Cardiol. 1993 Apr;21(5):1181-5. doi: 10.1016/0735-1097(93)90243-t.
We compared the results of percutaneous angioscopy and angiography for detecting critical elements of surface lesion morphology in 21 patients undergoing balloon angioplasty of saphenous vein coronary bypass grafts.
Angiography remains the standard for diagnosing and treating intravascular pathology associated with atherosclerotic coronary artery disease. It has been demonstrated that coronary angioscopy is more sensitive for identifying more complex atherosclerotic plaques and intracoronary thrombi in native coronary arteries.
Angioscopy and angiography were performed before and after angioplasty of "culprit lesions" in bypass grafts. All but one of the patients had unstable angina. The mean age of the saphenous vein coronary bypass grafts was 10.1 +/- 2.4 years (range 5 to 15).
Restenosis at a prior angioplasty site was present in seven patients. Intravascular thrombi were seen by angioscopy in 15 (71%) of 21 versus 4 (19%) of 21 grafts by angiography (p < 0.001). Dissection was identified by angioscopy in 14 (66%) of 21 versus 2 (9.5%) of 21 grafts by angiography (p < 0.01). The presence of friable plaque lining the lumen surface of the vein graft was detected by angioscopy in 11 (52%) of 21 versus 4 (19%) of 21 grafts by angiography (p < 0.05). There was no correlation between age of the bypass graft and the finding of friable plaque.
We conclude that angioscopy is superior to angiography for detecting complex lesion morphology in bypass grafts and that the presence of friable plaque does not preclude an uncomplicated angioplasty procedure.
我们比较了经皮血管镜检查和血管造影在检测21例接受大隐静脉冠状动脉旁路移植血管球囊血管成形术患者的表面病变形态关键要素方面的结果。
血管造影仍然是诊断和治疗与动脉粥样硬化性冠状动脉疾病相关的血管内病变的标准方法。已有研究表明，冠状动脉血管镜检查在识别天然冠状动脉中更复杂的动脉粥样硬化斑块和冠状动脉内血栓方面更敏感。
在旁路移植血管的“罪犯病变”血管成形术前后进行血管镜检查和血管造影。除1例患者外，所有患者均患有不稳定型心绞痛。大隐静脉冠状动脉旁路移植血管的平均年龄为10.1±2.4岁（范围5至15岁）。
7例患者在先前血管成形术部位存在再狭窄。通过血管镜检查，21例移植血管中有15例（71%）发现血管内血栓，而通过血管造影，21例移植血管中只有4例（19%）发现（p<0.001）。通过血管镜检查，21例移植血管中有14例（66%）发现夹层，而通过血管造影，21例移植血管中只有2例（9.5%）发现（p<0.01）。通过血管镜检查，21例移植血管中有11例（52%）发现静脉移植物管腔表面有易碎斑块，而通过血管造影，21例移植血管中只有4例（19%）发现（p<0.05）。旁路移植血管的年龄与易碎斑块的发现之间无相关性。
我们得出结论，在检测旁路移植血管中的复杂病变形态方面，血管镜检查优于血管造影，并且易碎斑块的存在并不排除血管成形术操作顺利。
