Ledesma M, Farell Campa J, Flores Flores J, Argüero Sánchez R
Hospital de Cardiología Centro Médico, Nacional Siglo XXI, Instituto Mexicano del Seguro Social, México D.F.
Arch Inst Cardiol Mex. 1996 Nov-Dec;66(6):467-75.
From February 1995 to April 1996 we performed intracoronary ultrasound (ICUS) in 32 patients who had percutaneous transluminal coronary angioplasty (PTCA). Eccentric plaques were found in 53% (n = 17) and concentric in 47% (n = 15). We found that 59.3% (n = 19) were soft, hard 21.8% (n = 7) and calcified plaques in 19% (n = 6). More than 40% of the plaques had some degree of calcium and most of them had dissection post PTCA ICUS deferred the procedure in 25% (n = 8) of cases. Seven of them were patients with late control post PTCA and no significant obstruction and a patient was found not to be a good candidate for PTCA. In 24 lesions we found morphology changes post PTCA: 41.6% type A, 12.5% type B, 45.8% type C, 8.3% type D, 90.9% type E1 and 9.1% type E2. Dissection was present in 54.1% post PTCA, ICUS information indicated other interventions (prolonged insufflations or stents). Two cases with acute coronary syndromes had smooth and fibrous plaques with excellent response to PTCA. Residual percentage stenosis post PTCA for quantitative coronary angiography was 23.7% and with ICUS 52.4%.
there were three cases with coronary spasm that responded well to nitroglycerin. In conclusion, ICUS provides information to evaluate results of PTCA. It also identifies complications and in some cases can improve results.
1995年2月至1996年4月，我们对32例行经皮冠状动脉腔内血管成形术（PTCA）的患者进行了冠状动脉内超声检查（ICUS）。发现53%（n = 17）的患者存在偏心斑块，47%（n = 15）为同心斑块。我们发现59.3%（n = 19）的斑块为软斑块，21.8%（n = 7）为硬斑块，19%（n = 6）为钙化斑块。超过40%的斑块有一定程度的钙化，且大多数在PTCA术后有夹层。ICUS使25%（n = 8）的病例推迟了手术。其中7例为PTCA术后晚期复查且无明显梗阻的患者，1例被发现不是PTCA的合适人选。在24个病变中，我们发现PTCA术后形态学改变：41.6%为A型，12.5%为B型，45.8%为C型，8.3%为D型，90.9%为E1型，9.1%为E2型。PTCA术后54.1%存在夹层，ICUS信息提示了其他干预措施（延长球囊充盈时间或置入支架）。2例急性冠状动脉综合征患者有光滑的纤维斑块，对PTCA反应良好。PTCA术后冠状动脉定量血管造影的残余狭窄百分比为23.7%，ICUS测量为52.4%。
3例冠状动脉痉挛患者对硝酸甘油反应良好。总之，ICUS为评估PTCA结果提供信息。它还能识别并发症，在某些情况下可改善治疗效果。
