Arko F, McCollough R, Manning L, Buckley C
Division of Vascular Surgery and Cardiology, Scott and White Clinic, Texas A&M University Health Science Center, Temple, USA.
Am J Surg. 1996 Nov;172(5):546-9; discussion 549-50. doi: 10.1016/S0002-9610(96)00232-2.
Intravascular ultrasound (IVUS) has been described as interesting technology in search of a clinical application by some and by others as a valuable diagnostic tool for many endovascular interventions. Its clinical usefulness has yet to be fully defined. When used during endovascular interventions, it can provide structural and diagnostic information, assess effectiveness of the therapy, and identify treatment-related complications.
Thirty-two consecutive patients with atherosclerotic aortoiliac occlusive disease who presented with 40 separate arterial lesions were evaluated with IVUS before and after balloon angioplasty and intraluminal stent placement. Information obtained from IVUS was compared with similar data obtained from simultaneous angiographic images. Both techniques were evaluated with respect to assessment of vessel size, lesion location, adequacy of therapy, and identification of complications.
Real time IVUS imaging compared with angiographic imaging showed that in 62% of the patients, vessel diameter was underassessed using angiographic criteria alone. More importantly, 40% (16 of the 40 lesions) had underdeployed stents by IVUS evaluation that appeared adequately expanded by angiographic criteria. Further stent expansion with a larger balloon was necessary to achieve accurate stent to vessel wall apposition. This was found to be significant by an exact binomial 95% confidence interval. Incomplete stent deployment has been identified as a possible cause for restenosis and vessel occlusion. Information obtained from IVUS imaging substantially altered the endovascular therapy in approximately 40% of our patients and provided valuable vessel sizing and lesion composition information in 62% of the patients.
Intravascular ultrasound can provide important diagnostic information that can alter the conduct of selected endovascular procedures. It is especially useful when the procedure requires deployment of arterial stents.
血管内超声（IVUS）被一些人描述为正在寻找临床应用的有趣技术，而另一些人则将其视为许多血管内介入治疗的有价值诊断工具。其临床实用性尚未完全明确。在血管内介入治疗期间使用时，它可以提供结构和诊断信息，评估治疗效果，并识别与治疗相关的并发症。
对32例连续患有动脉粥样硬化性主髂动脉闭塞性疾病且有40个独立动脉病变的患者，在球囊血管成形术和腔内支架置入术前和术后进行IVUS评估。将IVUS获得的信息与同时获得的血管造影图像的类似数据进行比较。对两种技术在血管大小评估、病变位置、治疗充分性和并发症识别方面进行评估。
与血管造影成像相比，实时IVUS成像显示，62%的患者仅使用血管造影标准时血管直径评估不足。更重要的是，通过IVUS评估，40%（40个病变中的16个）的支架展开不足，而血管造影标准显示这些支架似乎已充分扩张。需要用更大的球囊进一步扩张支架，以实现支架与血管壁的准确贴合。通过精确二项式95%置信区间发现这具有显著性。支架展开不完全已被确定为再狭窄和血管闭塞的可能原因。IVUS成像获得的信息在约40%的患者中显著改变了血管内治疗，并在62%的患者中提供了有价值的血管大小和病变组成信息。
血管内超声可以提供重要的诊断信息，从而改变某些血管内手术的操作。当手术需要置入动脉支架时，它特别有用。
