Tanaka K, Nishino M, Tanouchi J
Division of Cardiology, Osaka Rosai Hospital.
Nihon Rinsho. 1998 Apr;56(4):942-6.
It is sometimes difficult to visualize the luminal borders of the vessel even by intracoronary ultrasound (ICUS), especially after coronary intervention. In this study, we evaluated the potential for improving visualization at intervention sites using contrast-enhanced ICUS and the suitable contrast agents for this procedure in humans. In 37 patients, ICUS (30 MHz) was performed with intracoronary injection (3 ml) of 7 different contrast preparations and without the contrast agents (control) after coronary intervention. The contrast agents used were as follows: saline solution, standard iomeprol, standard ioxaglate, sonicated iomeprol, sonicated ioxaglate, 50% Albunex, and 100% Albunex. Vessel wall delineation, contrast homogeneity (Grade 0-3), peak contrast intensity and shadowing were examined. Homogeneous and complete opacification of the vessel lumen and false lumen was observed with sonicated ioxaglate, 50% and 100% Albunex. Shadowing was not observed at all with sonicated ioxaglate and was uncommon with 50% Albunex, whereas 100% Albunex caused shadowing in all cases. The coronary delineation rate with the other contrast agents was only 50-70 %, and the homogeneity and peak intensity were relatively low. Thus, sonicated ioxaglate and 50 % Albunex both achieved good visualization, but the former is cheaper, stable and takes shorter to prepare. Large dissection in 5 patients were found by contrast-enhanced ICUS' whereas they were not detected by coronary angiography. All of them needed additional interventional therapy due to the results of contrast-enhanced ICUS. In conclusion, contrast-enhanced ICUS is useful for evaluation of the results by intervention therapy, and of the agents we studied sonicated ioxaglate is best for contrast-enhanced ICUS.
即使通过冠状动脉内超声（ICUS），有时也难以清晰显示血管的管腔边界，尤其是在冠状动脉介入治疗后。在本研究中，我们评估了使用对比增强型ICUS改善介入部位可视化的潜力，以及适用于该操作的对比剂在人体中的应用情况。对37例患者在冠状动脉介入治疗后进行ICUS（30 MHz）检查，分别冠状动脉内注射（3 ml）7种不同的对比剂制剂以及不使用对比剂（对照）。所使用的对比剂如下：生理盐水、标准碘海醇、标准碘克沙醇、声振碘海醇、声振碘克沙醇、50%白蛋白微球和100%白蛋白微球。检查血管壁的清晰度、对比均匀性（0 - 3级）、峰值对比强度和伪像。声振碘克沙醇、50%和100%白蛋白微球可观察到血管腔和假腔的均匀且完全显影。声振碘克沙醇完全未观察到伪像，50%白蛋白微球较少见，而100%白蛋白微球在所有病例中均导致伪像。其他对比剂的冠状动脉显影率仅为50 - 70%，均匀性和峰值强度相对较低。因此，声振碘克沙醇和50%白蛋白微球均能实现良好的可视化，但前者更便宜、稳定且制备时间更短。对比增强型ICUS发现5例患者存在大的夹层，而冠状动脉造影未检测到。由于对比增强型ICUS的结果，所有这些患者都需要额外的介入治疗。总之，对比增强型ICUS有助于评估介入治疗的结果，在我们研究的对比剂中，声振碘克沙醇最适合用于对比增强型ICUS。
