Seo T, Yamao K, Hayashi T, Kotake C, Toda T, Kobayashi K, Yokota Y
Cardiovascular Department, Osaka Nakatsu Saiseikai Hospital.
J Cardiol. 1996 Oct;28(4):183-9.
Intravascular ultrasound (IVUS) imaging was used to measure internal luminal area immediately after percutaneous transluminal coronary angioplasty (PTCA) in 83 patients (59 males, 24 females, mean age 63 +/- 12 years) with angina pectoris to determine the need for additional intervention. The effectiveness of these interventions to prevent restenosis was also studied. Thirty-five patients (42%) with insufficient dilatation revealed an internal luminal area less than 5 mm2 or luminal stenosis greater than 60% as evaluated by IVUS imaging following the procedure. The luminal area increased from 4.5 +/- 1.1 to 7.9 +/- 2.8 mm2 and the percentage luminal stenosis improved from 66 +/- 9% to 54 +/- 9% in patients who underwent further dilatation with a larger size balloon, longer dilatation time, directional coronary atherectomy, or stenting. The insufficient dilatation group exhibited hard plaque and calcification more frequently than in the other group (48 patients, 58%) in whom sufficient dilatation of the target lesion was achieved. The incidence of restenosis in the sufficient dilatation group was 25%, compared to 33% of the patients receiving additional treatment after IVUS imaging and 42% in the 192 patients who underwent PTCA without IVUS imaging. IVUS imaging is a useful method for evaluation of complex luminal morphology to decrease the incidence of restenosis and for determination of the end point and the extent of dilatation required.
采用血管内超声（IVUS）成像技术，对83例（男59例，女24例，平均年龄63±12岁）心绞痛患者经皮腔内冠状动脉成形术（PTCA）后即刻测量其管腔内径，以确定是否需要进一步干预。同时研究了这些干预措施预防再狭窄的有效性。35例（42%）扩张不充分的患者，术后经IVUS成像评估显示管腔内径小于5mm²或管腔狭窄大于60%。接受更大尺寸球囊进一步扩张、更长扩张时间、定向冠状动脉斑块旋切术或支架置入术的患者，其管腔面积从4.5±1.1mm²增加至7.9±2.8mm²，管腔狭窄百分比从66±9%改善至54±9%。与成功实现靶病变充分扩张的另一组（48例，58%）相比，扩张不充分组硬斑块和钙化更为常见。充分扩张组的再狭窄发生率为25%，而IVUS成像后接受额外治疗的患者为33%，未行IVUS成像而接受PTCA的192例患者为42%。IVUS成像对于评估复杂的管腔形态以降低再狭窄发生率、确定终点以及所需扩张范围是一种有用的方法。
