Görge G, Ge J, Baumgart D, von Birgelen C, Erbel R
Department of Heart and Lung Disease, Medical Intensive Care and Angiology, Academic Teaching Hospital, Saarbrücken, Germany.
Basic Res Cardiol. 1998 Aug;93(4):219-40. doi: 10.1007/s003950050090.
Intravascular ultrasound (IVUS) has emerged from being a research tool to becoming an intrinsic part of modern invasive cardiology mainly due to imaging micro anatomy in vivo. For the first time, it is possible to base therapeutic decisions not only on lumenograms but also on vessel wall assessment. IVUS has both diagnostic and intervention associated potential. The diagnostic strength of IVUS is its ability to describe compensatory coronary artery enlargement as a response to arteriosclerosis, to assess intermediate lesions, and to reveal occult left main stem disease and angiographically "silent" arteriosclerosis. The intervention associated potential of IVUS is the optimal device selection, i.e., rotablators in calcified lesions or atherectomy devices in large plaque burden. The effects of PTCA on vessel wall morphology can be studied in great detail and the effect on luminal gain can be assessed. Several groups have shown that the residual plaque area ("plaque burden") even after angiographically successful PTCA still lies in the range of 60%. A significant reduction in this number may influence long-term outcome after PTCA. Minimal luminal area and residual plaque area after PTCA seem to be indicators of restenosis, while the presence or absence of dissections seems to be less predictive. The main mechanism of restenosis after PTCA is vessel shrinkage, not intimal hyperplasia. Intravascular monitoring of stent expansion led to high-pressure stent deployment with a significant increase in post-procedural luminal diameters and the ability to withhold anticoagulation in patients with optimal stent deployment. In pulmonary and aortic diseases, IVUS contributed significantly to the understanding of aortic dissection and pulmonary hypertension. Additionally, with intracardiac ultrasound left and right ventricular function can be assessed. Intracardiac ultrasound has gained clinical usefulness for guiding transcatheter ablation in patients with conduction system abnormalities. In the future, integrated devices, such as balloons on IVUS catheters, steerable catheters, integrated flow and pressure transducers, tissue characterization, and 0.018" IVUS guide wire will further enhance the usefulness of IVUS.
血管内超声（IVUS）已从一种研究工具发展成为现代介入心脏病学的一个固有组成部分，这主要归功于其能够在体内对微观解剖结构进行成像。首次有可能不仅根据管腔造影图，还根据血管壁评估来做出治疗决策。IVUS具有诊断和与干预相关的潜力。IVUS的诊断优势在于其能够描述作为对动脉硬化反应的代偿性冠状动脉扩张、评估中等病变以及揭示隐匿性左主干疾病和血管造影“隐匿性”动脉硬化。IVUS与干预相关的潜力在于最佳器械选择，即在钙化病变中使用旋磨术器械或在大斑块负荷中使用斑块切除术器械。可以非常详细地研究经皮冠状动脉腔内血管成形术（PTCA）对血管壁形态的影响，并评估其对管腔增益的影响。几个研究小组表明，即使在血管造影成功的PTCA术后，残余斑块面积（“斑块负荷”）仍在60%的范围内。这一数字的显著降低可能会影响PTCA术后的长期预后。PTCA术后的最小管腔面积和残余斑块面积似乎是再狭窄的指标，而夹层的有无似乎预测性较小。PTCA术后再狭窄的主要机制是血管收缩，而非内膜增生。对支架扩张进行血管内监测可实现高压支架置入，术后管腔直径显著增加，并且在支架置入最佳的患者中能够停用抗凝治疗。在肺部和主动脉疾病中，IVUS对理解主动脉夹层和肺动脉高压有显著贡献。此外，通过心腔内超声可以评估左右心室功能。心腔内超声在指导传导系统异常患者进行经导管消融方面已具有临床实用性。未来，集成设备，如IVUS导管上的球囊、可操纵导管、集成流量和压力传感器、组织特征分析以及0.018英寸IVUS导丝，将进一步提高IVUS的实用性。
