Ledesma M, Montoya Guerrero A, Antezana Castro J, Farell Campa J, Flores Flores J, Justiniano Cordero S, Camacho Franco V M, Argüero Sánchez R
Hospital de Cardiología del Centro Médico Nacional Siglo XXI. Instituto Mexicano del Seguro Social. México D.F.
Arch Inst Cardiol Mex. 1996 Jul-Aug;66(4):313-21.
From February 1995 to February 1996, 52 patients underwent intravascular ultrasound (IVUS) imaging: three with aortic coarctation (AoCo), one with persistent ductus arteriosus (PDA), 5 with rheumatic heart disease (RHD) and normal coronary arteries by angiography, one with muscular bridge in anterior descending artery, 20 with percutaneous transluminal coronary angioplasty PTCA (Group I), one of them with eximer laser and 22 stents (Group II). In patients with AoCo was possible to observe obstruction mechanism and the effect of dilation. In patient with PDA we measured the diameter of ductus. In patients with RHD we found early atherosclerosis in four cases, no detected by angiography. In Group I, we found soft plaque in 8, fibrous/mixed in 7 and calcified plaque with the calcium located superficially near the lumen in 5, concentric in 6 and 14 eccentric plaques. In this group the objective was observational in most of the cases, except when the imaging was characteristic of mayor dissection or small final lumen. In 10 cases we observed fracture or dissection of the plaque, in some with small flaps into the lumen. In the last two cases, IVUS was used to optimize results after PTCA in one, in the other we postponed the procedure because the characteristics of the lesion (severe superficial calcification). The patient who underwent eximer laser, IVUS demonstrated irregular and small lumen and was followed by PTCA. In Group II, IVUS was used to optimize deployment of stents. We did not have any case with subacute thrombosis.
Only four cases had angina with ischemic ECG changes during the procedure, but reverted after catheter pullback and intracoronary nitroglycerin. In summary, IVUS gives information about mechanism of obstruction, its complications and results of PTCA. Also detect early atherosclerotic disease not observed by angiography. Optimize deployment of stents and avoids cumarinic anticoagulation in most of the patients. Rational selection of device or deferral of the procedure is possible if we know the characteristics of the plaque before intervention. Utility in other cardiovascular diseases is limited at this time. It's a safe procedure, the morbidity is low and in our experience, without mortality. In the future this new technology will bring useful information in other types of coronary arteries diseases.
1995年2月至1996年2月，52例患者接受了血管内超声（IVUS）成像检查：3例主动脉缩窄（AoCo）、1例动脉导管未闭（PDA）、5例风湿性心脏病（RHD）且血管造影显示冠状动脉正常、1例前降支有肌桥、20例行经皮腔内冠状动脉成形术（PTCA）（第一组），其中1例使用准分子激光和22例植入支架（第二组）。对于主动脉缩窄患者，能够观察到梗阻机制及扩张效果。对于动脉导管未闭患者，我们测量了导管直径。对于风湿性心脏病患者，我们发现4例存在早期动脉粥样硬化，血管造影未检测到。在第一组中，我们发现8例为软斑块，7例为纤维/混合斑块，5例钙化斑块且钙位于靠近管腔的浅表位置，6例为同心斑块，14例为偏心斑块。在该组中，大多数情况下目的是观察，除非成像显示为主要夹层或小的最终管腔特征。在10例中我们观察到斑块破裂或夹层，部分伴有小的瓣片突入管腔。在最后2例中，1例IVUS用于优化PTCA术后结果，另1例因病变特征（严重浅表钙化）我们推迟了手术。接受准分子激光治疗的患者，IVUS显示管腔不规则且小，随后进行了PTCA。在第二组中，IVUS用于优化支架置入。我们没有出现任何亚急性血栓形成的病例。
仅4例在手术过程中出现心绞痛且伴有缺血性心电图改变，但在回撤导管及冠状动脉内注射硝酸甘油后恢复。总之，IVUS可提供关于梗阻机制、其并发症及PTCA结果的信息。还能检测到血管造影未观察到的早期动脉粥样硬化疾病。优化支架置入并在大多数患者中避免使用香豆素抗凝。如果在干预前了解斑块特征，就有可能合理选择器械或推迟手术。目前其在其他心血管疾病中的应用有限。这是一种安全的手术，发病率低，根据我们的经验，无死亡率。未来这项新技术将为其他类型的冠状动脉疾病带来有用信息。
