Leertouwer T C, Gussenhoven E J, van Overhagen H, Man in 't Veld A J, van Jaarsveld B C
Department of Internal Medicine, University Hospital Rotterdam-Dijkzigt and Erasmus University Rotterdam, The Netherlands.
J Vasc Interv Radiol. 1998 Nov-Dec;9(6):945-52. doi: 10.1016/s1051-0443(98)70428-2.
To study the impact of intravascular ultrasound (IVUS) during renal artery stent placement.
Patients (n = 22) with atherosclerotic renal artery stenosis were studied with IVUS after predilation and after angiographically successful stent deployment (diameter stenosis < 10%). After predilation, IVUS was used to assess whether the balloon size selected angiographically was correct (discrepancy balloon-reference lumen diameter < 20%). After stent placement, IVUS images were assessed for (i) complete stent-vessel wall apposition; (ii) complete stent expansion (discrepancy stent-reference lumen diameter < 20%), and (iii) complete lesion covering by the stent. Modification based on IVUS included selection of a larger balloon, additional dilation, and placement of a second stent. Clinical outcome was based on blood pressure, amount of antihypertensive drugs, and glomerular filtration rate during follow-up of 3 months.
Stent placement and ultrasound imaging were completed successfully in 18 patients. After predilation, IVUS warranted the use of a larger balloon in five patients. After stent placement, incomplete stent apposition (n = 1), discrepancy between stent and reference lumen diameter (n = 3), and lesion distal to the stent (n = 2) seen on IVUS were treated with additional dilation in five patients and with a second stent in one patient. A larger balloon was used in three patients. Mean blood pressure and amount of antihypertensive drugs decreased (P < .05).
In a number of patients, IVUS monitoring during renal artery stent placement resulted in additional lumen enlargement not considered necessary at angiography.
研究血管内超声（IVUS）在肾动脉支架置入过程中的作用。
对22例动脉粥样硬化性肾动脉狭窄患者在预扩张后及血管造影成功置入支架后（直径狭窄<10%）进行IVUS检查。预扩张后，使用IVUS评估血管造影选择的球囊尺寸是否正确（球囊-参考管腔直径差异<20%）。支架置入后，对IVUS图像进行评估，包括：（i）支架与血管壁完全贴合；（ii）支架完全扩张（支架-参考管腔直径差异<20%），以及（iii）支架完全覆盖病变。基于IVUS的调整包括选择更大的球囊、额外扩张以及置入第二个支架。临床结局基于3个月随访期间的血压、抗高血压药物用量和肾小球滤过率。
18例患者成功完成支架置入和超声成像。预扩张后，IVUS显示5例患者需要使用更大的球囊。支架置入后，5例患者因IVUS显示支架贴壁不完全（n = 1）、支架与参考管腔直径差异（n = 3）以及支架远端病变（n = 2）接受了额外扩张，1例患者置入了第二个支架。3例患者使用了更大的球囊。平均血压和抗高血压药物用量降低（P <.05）。
在一些患者中，肾动脉支架置入过程中的IVUS监测导致了血管造影时未认为必要的额外管腔扩大。
