Baptista J, di Mario C, Ozaki Y, Escaned J, Gil R, de Feyter P, Roelandt J R, Serruys P W
Intracoronary Imaging and Catheterisation Laboratories, Erasmus University, Rotterdam, The Netherlands.
Am J Cardiol. 1996 Jan 15;77(2):115-21. doi: 10.1016/s0002-9149(96)90579-2.
Limited information is provided by angiography on plaque morphology and composition before balloon angioplasty. Identification of plaques associated with reduced lumen gain or a high complication rate may provide the rationale for using alternative revascularization devices. We studied 60 patients with quantitative angiography and intracoronary ultrasound (ICUS) before and after balloon dilation. Angiography was used to measure transient wall stretch and elastic recoil. ICUS was used to investigate the mechanisms of lumen enlargement among different plaque compositions and in the presence of a disease-free wall (minimal thickness < or = 0.6 mm). Compared with ultrasound, angiography underestimated the presence of vessel calcification (13% vs 78%), lumen eccentricity (35% vs 62%), and wall dissection (32% vs 57%). ICUS measurements showed that balloon angioplasty increased lumen area from 1.82 +/- 0.51 to 4.81 +/- 1.43 mm2. Lumen enlargement was the result of the combined effect of an increase in the total cross-sectional area of the vessel (wall stretching, 43%) and of a reduction in the area occupied by the plaque (plaque compression or redistribution, 57%). Vessels with a disease-free wall had smaller lumen gain than other types of vessels (2.13 +/- 1.26 vs 3.59 +/- mm2, respectively, p < 0.01). Wall stretching was the most important mechanism of lumen enlargement in vessels with a disease-free wall (79% vs 37% in the other vessels). Angiography revealed a direct correlation between temporary stretch and elastic recoil that was responsible for 26% of the loss of the potential lumen gain. Thus, lumen enlargement after balloon angioplasty is the combined result of wall stretch and plaque compression or redistribution. ICUS indicates that vessels with a remnant arc of disease-free wall are dilated mainly by wall stretching compared with other types of vessels and are associated with a smaller lumen gain.
血管造影术在球囊血管成形术前提供的斑块形态和成分信息有限。识别与管腔增益降低或高并发症发生率相关的斑块可为使用替代血管重建装置提供理论依据。我们对60例患者在球囊扩张前后进行了定量血管造影和冠状动脉内超声检查（ICUS）。血管造影术用于测量瞬时壁伸展和弹性回缩。ICUS用于研究不同斑块成分以及存在无病变壁（最小厚度≤0.6mm）时管腔扩大的机制。与超声相比，血管造影术低估了血管钙化（13%对78%）、管腔偏心（35%对62%）和壁夹层（32%对57%）的存在。ICUS测量显示，球囊血管成形术使管腔面积从1.82±0.51增加到4.81±1.43mm²。管腔扩大是血管总横截面积增加（壁伸展，43%）和斑块所占面积减少（斑块压缩或重新分布，57%）共同作用的结果。有无病变壁的血管管腔增益小于其他类型血管（分别为2.13±1.26对3.59±mm²，p<0.01）。壁伸展是有无病变壁血管管腔扩大的最重要机制（79%对其他血管的37%）。血管造影术显示临时伸展与弹性回缩之间存在直接相关性，这导致潜在管腔增益损失的26%。因此，球囊血管成形术后管腔扩大是壁伸展和斑块压缩或重新分布的共同结果。ICUS表明，与其他类型血管相比，有无病变壁残余弧的血管主要通过壁伸展扩张，且管腔增益较小。
