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Journal of Medical Ultrasonics

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1994 - Vol.21

Vol.21 No.01

Original Article(原著)

(0022 - 0030)


Intravascular Ultrasound Images After Atherectomy for Occlusive Peripheral Vascular Disease

中村 陽一1, 横井 良明1, 木村 素子1, 横家 正樹1, 吉田 成彦2, 東上 震一2, 上田 真喜子3

Youichi NAKAMURA1, Yoshiaki YOKOI1, Motoko KIMURA1, Masaki YOKOYA1, Shigehiko YOSHIDA2, Shinichi HIGASHIUE2, Makiko UEDA3

1岸和田徳洲会病院循環器内科, 2岸和田徳洲会病院心臓血管外科, 3大阪市立大学第1病理

1Department of Cardiology, Kishiwada Tokusyukai Hospital, 2Department of Cardiovascular surgery, Kishiwada Tokusyukai Hospital, 3Department of Pathology, Osaka city University Medical School

キーワード : Intravascular ultrasound system (IVUS), Atherectomy, Medial dissection, Intimal injury, Occlusive peripheral vascular disease

Intravascular ultrasound system (IVUS) was used to assess the immediate effect of atherectomy on peripheral atherosclerosis in 13 patients. The arteries treated and examined included the iliac in eleven lesions and the superficial femoral in sixteen. Balloon angioplasty was employed as pre-dilatation in 20 lesions. The mean diameter of stenosis was reduced from 70.2±23.8% to 20.6±11.2%. However, IVUS data revealed that mean cross sectional area stenosis after atherectomy was 49.8±12.1%. IVUS findings at the site of atherectomy suggest that the angiographic assessment underscores luminal narrowing. The morphological information provided by IVUS showed 10 intimal injuries (50%) and 5 medial dissections (25%) in lesions with balloon angioplasty performed as pre-dilatation. There was only one intimal injury (14%) in primary atherectomized sites. Plaque cracks and/or dissection was less prominent in the arteries treated with primary atherectomy. Pathological examination of the resected tissues revealed medial elements in only one lesions. However, the information provided by IVUS could not identify the medial resections. The observations recorded in this preliminary group of 13 patients illustrate the potential utility of IVUS for patients undergoing percutaneous revascularization.