INTRAVASCULAR ULTRASOUND STUDY OF ANGIOGRAPHICALLY MILDLY DISEASED CORONARY-ARTERIES
INTRAVASCULAR ULTRASOUND STUDY OF ANGIOGRAPHICALLY MILDLY DISEASED CORONARY-ARTERIES
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DOI：
10.1016/0735-1097(93)90770-2
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发表时间：
1993-12-01
影响因子：
24
通讯作者：
SHURMUR, S
中科院分区：
文献类型：
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作者：
PORTER, TR;SEARS, T;SHURMUR, S
目标.我们假设血管内超声可以识别轻微病变或单支或双支冠状动脉病变患者的冠状动脉狭窄。尸检研究表明，冠状动脉造影术可能低估了轻度病变血管的狭窄程度。血管内超声已被证明可以检测血管造影正常冠状动脉的动脉粥样硬化变化，并与组织学结果更好地相关。在20例患者中，我们对37支冠状动脉进行了血管内超声成像（3.5F导管，30 MHz探头），这些冠状动脉通过定性血管造影被认为是轻度病变（直径狭窄< 50%）。血管造影诊断为8例无明显冠状动脉病变，7例单支病变，5例双支病变。除左冠状动脉主干外，将每支血管分为近段、中段和远段。狭窄面积百分比和最小管腔直径随后通过超声和定量血管造影进行定量。在所研究的67个节段中，超声测量的平均最大动脉面积狭窄率为36 +/- 20%（范围为0%至80.2%），相同节段的定量血管造影测量的平均最大动脉面积狭窄率为19 +/- 23%（范围为0%至82%）（p < 0.001，配对t检验）。通过超声测量，节段的平均最小管腔直径为3.3 ± 0.9 mm，通过定量血管造影测量，节段的平均最小管腔直径为2.7 ± 0.8 mm。在10例患者中，有19个血管造影轻度病变节段，超声显示动脉面积狭窄百分比大于或等于50%。血管内超声显示，在19个低估的节段中，12个节段的更近端（参考）节段的内膜增厚> 25%。在6个狭窄节段（32%）中，由于代偿性扩张，总血管面积较相邻近端血管节段增加。血管内超声可识别血管造影显示仅轻度病变的血管中潜在的显著冠状动脉疾病。
Objectives. We hypothesized that intravascular ultrasound may identify significant coronary artery narrowing in the mildly diseased coronary artery of patients with insignificant or one- or two-vessel coronary artery disease.Background. Necropsy studies have revealed that coronary angiography may underestimate stenosis severity in vessels that appear mildly diseased. Intravascular ultrasound has been shown to detect atherosclerotic changes in angiographically normal coronary arteries and to correlate better with histologic findings.Methods. In 20 patients, we performed intravascular ultrasound imaging (3.5F catheter, 30-MHz transducer) in 37 coronary arteries that were considered mildly diseased ( < 50% diameter narrowing) by qualitative angiography. The angiographic diagnosis was no significant coronary artery disease in eight patients, one-vessel disease in seven and two-vessel disease in five. Each vessel, except for the left main coronary artery, was divided into proximal, mid and distal segments. Percent area narrowing and minimal lumen diameter were subsequently quantified by both ultrasound and quantitative angiography.Results. Mean maximal arterial area narrowing by ultrasound in the 67 segments studied was 36 +/- 20% (range 0% to 80.2%) and 19 +/- 23% (range 0% to 82%) by quantitative angiography of these same segments (p < 0.001, paired t test). Mean minimal lumen diameter of the segments was 3.3 +/- 0.9 mm by ultrasound and 2.7 +/- 0.8 mm by quantitative angiography. In 10 patients there were 19 angiographically mildly diseased segments where the percent arterial area narrowing by ultrasound was greater than or equal to 50%. Intravascular ultrasound revealed that the more proximal (reference) segment had > 25% intimal thickening in 12 of the 19 underestimated segments. In six stenosed segments (32%), total vessel area increased compared with that of the adjacent proximal vessel segment because of compensatory dilation.Conclusions. Intravascular ultrasound identifies potentially significant coronary artery disease in vessels that appear to be only mildly diseased by angiography.