Albrecht D, Kaspers S, Füssl R, Höpp H W, Sechtem U
Klinik III für Innere Medizin, Universität zu Köln, Cologne, Federal Republic of Germany.
Cathet Cardiovasc Diagn. 1996 Jul;38(3):229-35. doi: 10.1002/(SICI)1097-0304(199607)38:3<229::AID-CCD1>3.0.CO;2-A.
The purpose of this study was to evaluate the changes in arterial wall morphology induced by coronary stent implantation and the influence of plaque morphology on stent expansion by intravascular ultrasound. Intravascular ultrasound imaging was performed in 25 lesions before and after Palmaz-Schatz stent implantation. In the 25 lesions with ultrasound images before and after stent deployment angiographic percent diameter stenosis decreased from 71% +/- 11% to 6% +/- 14%. By ultrasound there was a gain in luminal area from 2.0 mm2 +/- 1.5 mm2 to 6.6 mm2 +/- 2.1 mm2 owing to gain in external elastic membrane area of 2.5 mm2 +/- 1.7 mm2 and reduction of plaque area of 2.1 mm2 +/- 1.7 mm2. Calcified lesions (n = 8) showed significantly less relative luminal gain (218% +/- 128% vs. 421% +/- 276%, P = .01), and stent expansion was significantly less symmetric (minimal/maximal stent diameter 0.8 +/- 0.1 vs. 0.9 +/- 0.1, P = .002) as compared to non-calcified lesions (n = 17). The difference in lumen area within the stent between the previously stenotic area and the ends of the stent was significantly larger in calcified lesions as compared to non-calcified lesions (29 +/- 28% vs. 8 +/- 23%, P = .03). Both vessel stretch and plaque reduction contribute to the luminal gain after coronary stenting. Calcified lesions interfere with optimal stent expansion.
本研究的目的是通过血管内超声评估冠状动脉支架植入引起的动脉壁形态变化以及斑块形态对支架扩张的影响。对25处病变在植入帕尔马兹-沙茨支架前后进行血管内超声成像。在25处有支架植入前后超声图像的病变中，血管造影显示直径狭窄百分比从71%±11%降至6%±14%。通过超声检查，管腔面积从2.0mm²±1.5mm²增加到6.6mm²±2.1mm²，这是由于外部弹性膜面积增加了2.5mm²±1.7mm²，斑块面积减少了2.1mm²±1.7mm²。钙化病变（n = 8）的相对管腔增益明显较小（218%±128%对421%±276%，P = 0.01），与非钙化病变（n = 17）相比，支架扩张明显更不对称（最小/最大支架直径0.8±0.1对0.9±0.1，P = 0.002）。与非钙化病变相比，钙化病变中支架内先前狭窄区域与支架两端之间的管腔面积差异明显更大（29±28%对8±23%，P = 0.03）。血管伸展和斑块缩小均有助于冠状动脉支架置入术后管腔增益。钙化病变会干扰支架的最佳扩张。
