Blasini R, Neumann F J, Schmitt C, Walter H, Schömig A
Deutsches Herzzentrum und 1. Medizinische Klinik, Klinikum rechts der Isar, der Technischen Universität, München, Germany.
Cathet Cardiovasc Diagn. 1998 Aug;44(4):380-6. doi: 10.1002/(sici)1097-0304(199808)44:4<380::aid-ccd3>3.0.co;2-0.
This study was designed to test the hypothesis that patients fulfilling intravascular ultrasound (IVUS) criteria for optimal coronary stent implantation show a reduction in the restenosis rate at 6 months. IVUS guidance for stent dilation may be associated with facilitated stent implantation and an increased acute luminal gain, but it has not yet been determined, whether and to what extent this procedure is associated with a reduction in the restenosis rate. IVUS-guided optimization of Palmaz-Schatz stent placement was performed in 125 consecutive patients, 64 of whom fulfilled IVUS-criteria for optimal stent placement. Another 125 patients served as the non-IVUS control group. In 107 patients (86%) of the non-IVUS control group and 105 patients (84%) of the IVUS group, angiographic follow-up was performed. The IVUS group of patients revealed a significantly lower restenosis rate of 20.9% as compared with 29.9% in the control group (P = 0.033). Patients that met IVUS criteria for optimal stent placement had a larger minimal lumen diameter immediately after stent implantation (3.13 +/- 0.44 vs. 2.95 +/- 0.47 mm; P = 0.045) and at 6-month follow-up (2.23 +/- 0.78 vs. 1.87 +/- 0.76 mm; P = 0.019) as well as a significantly lower restenosis rate (13.5% vs. 28.3%; P = 0.038) as compared with patients that did not fulfil these criteria. Our data suggest that patients fulfilling IVUS criteria for optimal stent placement demonstrate a reduced risk for the development of restenosis. Thus, IVUS investigation identifies factors predictive of restenosis after coronary stent placement.
符合血管内超声（IVUS）最佳冠状动脉支架植入标准的患者，其6个月时的再狭窄率会降低。支架扩张的IVUS引导可能与支架植入更顺利及急性管腔增益增加有关，但该操作是否以及在何种程度上与再狭窄率降低相关，目前尚未确定。对125例连续患者进行了IVUS引导下的Palmaz-Schatz支架置入优化，其中64例符合IVUS最佳支架置入标准。另外125例患者作为非IVUS对照组。非IVUS对照组的107例患者（86%）和IVUS组的105例患者（84%）进行了血管造影随访。IVUS组患者的再狭窄率显著低于对照组，分别为20.9%和29.9%（P = 0.033）。符合IVUS最佳支架置入标准的患者在支架植入后即刻（3.13±0.44 vs. 2.95±0.47 mm；P = 0.045）和6个月随访时（2.23±0.78 vs. 1.87±0.76 mm；P = 0.019）的最小管腔直径更大，且再狭窄率显著更低（13.5% vs. 28.3%；P = 0.038）。我们的数据表明，符合IVUS最佳支架置入标准的患者发生再狭窄的风险降低。因此，IVUS检查可识别冠状动脉支架置入后再狭窄的预测因素。
