Görge G, Ge J, Haude M, Shah V, Jeremias A, Simon H, Erbel R
Department of Cardiology, University Hospital, Essen, Germany.
Herz. 1996 Apr;21(2):78-89.
Intravascular ultrasound (IVUS) has emerged form a research tool to an intrinsic part of modern invasive cardiology. The main reason is the capability to obtain "in vivo" histology. For the first time it is possible to base decisions not only on lumenograms but also on vessel wall assessment. The capabilities of IVUS can be divided in its (a) diagnostic and (b) intervention associated potentials. Diagnostic strength of IVUS is the ability to monitor compensatory coronary artery enlargement as a response to arteriosclerosis, to assess intermediate lesions, to reveal occult left main stem disease, and angiographycally "silent" arteriosclerosis. The intervention associated potentials of IVUS are the ability to allow optimal device selection, i.e. rotablators in calcified lesions or atherectomy devices in large plaque burden. The effects of PTCA on vessel wall morphology can be studied in great detail and the effect on luminal gain can be assessed almost on-line. Several groups showed, that the residual plaque area even after angiographycally successful PTCA lies still in the range of 60%. A significant reduction of this number may influence longterm outcome after PTCA. Minimal luminal areas and residual plaque area after PTCA seem to be an indicator of restenosis, while the presence or absence of dissections seem to be less predictive. Intravascular monitoring of stent expansion led to high-pressure stent deployment with significant increase in post-procedural luminal diameters and finally the ability to withhold anticoagulation in patients with optimal stent deployment. In the future, integrated devices, like balloons on intravascular ultrasound catheters, steerable catheters, integrated flow and pressure transducers, tissue characterization, and 0.018 "intravascular ultrasound guide-wires will further enhance the usefulness of IVUS.
血管内超声（IVUS）已从一种研究工具发展成为现代介入心脏病学不可或缺的一部分。主要原因是其具备获取“体内”组织学信息的能力。首次不仅能够依据血管造影图，还能基于血管壁评估来做出决策。IVUS的功能可分为（a）诊断功能和（b）与介入相关的功能。IVUS的诊断优势在于能够监测冠状动脉对动脉硬化的代偿性扩张、评估中等病变、发现隐匿性左主干病变以及血管造影显示“无异常”的动脉硬化。IVUS与介入相关的功能包括能够实现最佳器械选择，例如在钙化病变中使用旋磨仪或在斑块负荷较大时使用斑块旋切装置。可以详细研究经皮冠状动脉腔内血管成形术（PTCA）对血管壁形态的影响，并且几乎可以实时评估其对管腔增益的影响。多个研究小组表明，即使在血管造影显示PTCA成功后，残余斑块面积仍处于60%的范围。这一数值的显著降低可能会影响PTCA后的长期预后。PTCA后的最小管腔面积和残余斑块面积似乎是再狭窄的一个指标，而夹层的有无似乎预测性较差。血管内监测支架扩张可实现高压支架置入，从而显著增加术后管腔直径，最终使支架置入理想的患者能够停用抗凝药物。未来，诸如血管内超声导管上的球囊、可操控导管、集成流量和压力传感器、组织特征分析以及0.018英寸血管内超声导丝等集成设备，将进一步提升IVUS的实用性。
