冠状动脉介入治疗中StentBoost技术的应用及其与血管内超声的比较

目的:探讨StentBoost技术增强冠状动脉支架显影及检测支架扩张不充分的可行性并与血管内超声(IVUS)进行比较。方法:2009-03至2009-06间我院17例同时行IVUS和StentBoost检查的患者资料,平均年龄(55.76±12.63)岁,32～79岁,其中男性13例(76.47%),女性4例(23.53%),分别对冠状动脉造影定量分析(QCA)、IVUS和StentBoost检测数据进行相关性分析。结果:最小支架直径IVUS与StentBoost的相关性(r=0.9733,P0.0001)优于QCA与StentBoost的相关性(r=0.9708,P0.0001),以及优于QCA与IVUS的相关性(r=0.9589,P0.0001),而支架偏心指数QCA与StentBoost的相关性最好(r=0.5527;P=0.021)。结论:与QCA相比,StentBoost和IVUS具有更好的相关性。     

支架影像增强显影技术在冠脉支架植入术中的应用效果观察

目的：评价支架增强显影（ SB）技术在冠脉支架植入术中的应用效果。方法将204例行冠状动脉支架植入术的患者随机分为观察组和对照组,各102例。两组均采用常规冠状动脉造影方法行冠状动脉造影,并在其指导下进行冠状动脉支架植入术。对照组支架植入后采用QCA自动分析系统测量支架直径的相关参数（包括支架直径的最小值、最大值、均值）并计算支架偏心指数。同时进行支架可视性和球囊内扩张必要性评分。观察组在支架植入后行SB,测量上述指标并进行上述评分。观察组26例支架植入后行血管内超声（ IVUS）检查,测量上述指标并进行上述评分。结果对照组支架植入后支架可视性得分低于观察组, P＜0．05。对照组发现30处、观察组发现48处有球囊内扩张必要性而行支架球囊内扩张术。两组QCA、SB、IVUS测得植入支架最小直径、最大直径、直径均值和支架偏心指数差异无统计学意义。 Pearson相关性分析显示QCA与SB、QCA与IVUS、SB与IVUS测得支架最小直径均有良好的相关性,r分别为0．772、0．775、0．782,P均＜0．05。结论 SB可明显提高支架的可视性,有效指导支架的球囊内扩张,在测量支架直径方面甚至可以替代冠脉内超声。     

血管内超声对复杂冠状动脉左主干病变患者介入治疗的指导价值

目的研究血管内超声(IVUS)对复杂冠状动脉左主干病变患者PCI的指导价值。方法收集2014年1月～2017年1月我科收治的复杂冠状动脉左主干病变并且行PCI的患者110例,分为对照组55例和观察组55例(PCI术中采用IVUS技术进行指导)。比较2组患者基本资料、最小管腔直径(MLD)、最小管腔面积(MLA)、面积狭窄率(AS)、支架直径及长度、支架释放压力、后扩张球囊压力及直径等指标;随访1年,观察2组靶病变血运重建和主要不良心脏事件(MACE)情况。结果观察组MLD[(2.17±0.36)mmvs (1.62±0.59)mm,P=0.000]、MLA[(4.94±1.61)mm~2 vs (2.51±1.77)mm~2,P=0.000]、支架直径[(3.54±0.24)mmvs (3.34±0.31)mm,P=0.002]、支架长度[(14.41±5.25)mmvs (12.11±4.21)mm,P=0.038]、后扩张球囊直径[(3.98±0.51)mmvs (3.77±0.38)mm,P=0.040]、后扩张球囊压力明显大于对照组(P=0.000),AS明显低于对照组[(63.23±8.17)%vs (77.31±7.42)%,P=0.000)];随访期观察组总MACE发生率虽低于对照组,但无统计学差异(9.09%vs 12.73%,P=0.540)。结论 IVUS能有效指导左主干病变PCI支架定位,辅助判断支架扩张和贴壁情况。     

支架影像增强技术StentBoost对支架后扩张的指导意义与血管内超声的比较分析

目的探讨支架影像增强技术StentBoost显影及判定支架后扩张的可行性及准确性。方法选择同时行血管内超声(IVUS)和StentBoost检查的心内科住院患者1 7例,其中无钙化患者3例,浅表钙化患者11例,深层钙化患者3例。其中14例因支架膨胀不均匀给予后扩张,分别对支架后扩张前后冠状动脉定量分析(QCA)、IVUS和StentBoost检测数据进行相关性分析。结果后扩张前支架内最小直径IVUS与StentBoost的相关性(r=0.9856,P0.01)优于QCA与StentBoost的相关性(r=0.9754,P0.01),也优于QCA与IVUS的相关性(r=0.9611,P0.01);后扩张后支架内最小直径QCA与StentBoost的相关性(r=0.8774,P0.01)最好。QCA、IVUS和StentBoost三者的相关性在深层钙化患者明显优于浅表钙化患者。结论支架后扩张前IVUS和StentBoost数据的相关性较好,而后扩张后两者相关性下降。     

支架影像增强显影技术在老年冠脉介入治疗患者中的应用

目的评价支架增强显影技术(SB)在老年冠脉介入患者中的应用价值。方法 2011年10月至2013年3月行冠脉介入治疗(PCI)老年患者102例为观察组,在冠状动脉造影定量分析(QCA)基础上,应用SB进行支架可视性评价和支架后扩张必要性评价;同期进行冠脉介入的老年患者102例作为对照组,单纯应用QCA冠状动脉造影定量分析进行支架可视性评价和支架后扩张必要性评价。通过标准的QCA和SB对支架可视性进行评价并分为1~4级(1级=差,2级=可,3级=良,4级=优)。经QCA定量分析、SB对球囊后扩张的必要性进行评价(球囊后扩张必要性:0=支架贴壁良好不需要后扩张;1=支架贴壁可,不需要后扩张;2=支架贴壁不良,需要后扩张)。结果 QCA显示支架可视性为(2.03±0.84)级(其中1级40个,2级71个,3级32个,4级8个),SB显示支架可视性为(2.79±0.84)级(其中1级14个,2级32个,3级82个,4级28个),两者相比,差异有统计学意义(P0.05)。根据QCA定量分析结果行球囊后扩张30次,根据SB评价结果行球囊后扩张48次,两者相比,差异有统计学意义(P0.001)。结论 SB可明显提高支架的可视性,有效指导支架的后扩张,在不增加手术时间和费用的基础上可能降低支架血栓形成的风险。     

双导丝球囊在冠状动脉分叉病变中的应用

目的:观察双导丝球囊在冠状动脉分叉病变应用中的有效及安全性。方法:本研究入选210例冠状动脉分叉病变患者,随机分为双导丝球囊组和普通球囊组。用定量冠状动脉造影的方法分别测量了术前、球囊扩张后、支架置入后分叉部位最小管腔直径、即刻管径获得和直径狭窄率。结果:研究的有效性指标,在球囊扩张后,使用双导丝球囊的病例与使用普通球囊的病例相比,前者边支血管的直径狭窄率更低[(43.38±16.81)vs.(51.68±15.01)%,P<0.01]、最小管腔直径更大[(1.34±0.47)vs.(1.15±0.39)mm,P<0.01]、即刻管径获得的绝对值更少[(-0.11±0.04)vs.(-0.25±0.09)mm,P<0.01],差异均具有统计学意义。170例患者在球囊扩张主支血管后置入了支架。双导丝球囊组与普通球囊组相比,前者边支血管的直径狭窄率更低[(50.34±16.82)vs.(66.09±22.60)%,P<0.01]、最小管腔直径更大[(1.14±0.40)vs.(0.93±0.34)mm,P<0.01]、即刻管径获得的绝对值更少[(-0.30±0.12)vs.(-0.54±0.19)mm,P<0.01],差异均具有统计学意义。安全性指标,血管夹层、边支闭塞、主要不良心血管事件发生率在两组间无明显差异。结论:用双导丝球囊扩张主支血管,边支血管受到的影响相对较小,这可能和导丝切割斑块的作用有关。双导丝球囊可能成为分叉病变介入治疗中的一种选择。     

定量冠状动脉造影对糖尿病患者靶病变及参考血管的评价

目的 对比血管内超声(IVUS)与定量冠状动脉造影(QCA)对于冠心病合并糖尿病患者靶病变和参考血管定量测量结果,评价QCA的准确性,以指导临床的干预治疗.方法 2型糖尿病患者52例,男35例,女27例,年龄(62.3±7.1)岁.接受QCA和IVUS检查.以IVUS测量最小面积处斑块负荷结果作为因变量,以QCA定量测量的病变血管狭窄程度作为自变量,进行相关和回归分析,得到相关系数,建立回归方程.并对比近、远端参考血管直径两类方法测量值.结果 QCA冠状动脉狭窄程度测量结果同IVUS最小面积处斑块负荷结果的回归方程(斜率:0.8286,P=0.001)显示二种方法的测量结果有明确的同步变化趋势和相关性(r=0.691,P＜0.001).但QCA测量结果(57.9%±15.5%)较ivus(53.5%±12.9%)高估了病变的严重程度(差值为4.6%±1.2%).本组患者为血管负性重构,重构指数(RI)为0.87±0.23.相对于近、远端参考血管的管腔直径测量误差[(0.24±0.06)mm和(0.07±0.01)mm]而言,QCA对近、远端参考血管的血管直径的测量误差[(0.81±0.24)mm和(0.64±0.17)mm]更为明显.结论由于糖尿病患者广泛的血管重构(尤其是负性重构),使QCA易高估罪犯血管严重程度.同时,QCA因无法准确显示斑块负荷,而导致造影显示为"正常"血管段,从而低估近远端参考血管直径.     

药物涂层球囊联合切割球囊预扩张在分叉病变中的应用探讨

目的观察药物涂层球囊(DCB)联合切割球囊预扩张在分叉病变中应用的安全性和有效性。方法选取2015年5月～2017年5月于平顶山市第二人民医院心内科经冠状动脉(冠脉)造影证实的冠脉分叉病变患者42例为研究对象,随机分为治疗组(21例)和对照组(21例),治疗组采用药物球囊联合切割球囊治疗分叉病变,对照组采用单纯球囊扩张技术治疗分叉病变,两组主支血管常规置入药物洗脱支架后行球囊常规后扩张处理。比较两组患者基线临床资料、冠脉病变特点、术后即刻及6个月随访的主支及分支病变血管最小内径(MLD)、分支晚期管腔丢失(LLL)、主要心血管不良事件(MACE)发生情况等。结果两组患者基线临床资料及冠脉病变特点比较,差异无统计学意义(P0.05)。两组主支病变血管MLD[(2.87±0.15)mm vs.(2.91±0.18)mm]及分支血管MLD[(2.26±0.18)mm vs.(2.36±0.19)mm]术后即刻差异无统计学意义(P0.05)。两组主支病变血管MLD[(2.58±0.22)mm vs.(2.69±0.17)mm]术后6个月随访差异无统计学意义(P0.05);两组分支血管MLD[(2.08±0.22)mm vs.(1.67±0.19)mm]术后6个月随访差异具有统计学意义(P0.05)。两组分支血管术后6个月随访LLL[(0.22±0.12)mm vs.(0.69±0.15)mm]差异具有统计学意义(P0.05)。两组主要心血管不良事件(MACE)发生情况(1 vs. 6)比较,差异具有统计学意义(P0.05)。结论药物涂层球囊联合切割球囊治疗冠状动脉分叉病变安全、有效,值得临床推广应用。     

血管内超声预测药物球囊致冠状动脉夹层的影响因素

目的:探究在血管内超声(intravascular ultrasound, IVUS)辅助下药物涂层球囊(drug-coated balloon, DCB)处理冠状动脉(冠脉)原位病变出现冠脉夹层的影响因素。方法:收集2020年1月—2021年6月于郑州大学第一附属医院在IVUS辅助下DCB处理冠脉原位病变患者的临床资料及影像资料进行回顾性分析。根据IVUS下是否观察到冠脉夹层,分为夹层组和无夹层组,使用logistic回归分析夹层的影响因素。结果:共纳入患者99例,其中夹层组较非夹层组有更长的药物球囊长度(30.33 mm vs 22.17 mm,P<0.05),更大的预扩球囊直径/IVUS下病变部位直径(0.92 vs 0.81,P<0.05)和药物球囊直径/IVUS下病变部位直径(0.95 vs 0.88,P<0.05),更低的左心室射血分数(58.23%vs 62.15%,P<0.05),更小的管腔面积(2.74 mm² vs 3.61 mm²,P<0.05)和平均管腔中膜面积(11.53 mm^...     

川芎嗪药物涂层支架预防猪冠状动脉再狭窄的实验研究

目的 探讨川芎嗪药物涂层支架(TES)预防冠状动脉再狭窄的作用机制及其有效性.方法 TES为金属管状支架经喷涂川芎嗪单体制成(含川芎嗪200μg).采用随机、双盲实验在14只小型猪的冠状动脉左前降支分别置入TES及金属裸支架(BMS)(实验组7只,对照组7只).支架置入前后均行定量冠状动脉造影(QCA)及血管内超声(IVUS)检查.术后第28天随访行QCA及ⅣUS观察支架内膜增殖及血栓形成情况.实验终点处死动物,获取支架置入段血管及支架前后5 cm处组织行病理学及免疫组化检查.结果 14只动物均成功置入支架,4只动物因手术意外死亡未列入统计.5只动物于左前降支置入TES,5只动物置入BMs.术后第28天随访,QCA检查支架段血管直径狭窄百分比两组分别为实验组(10.0±2.1)%和对照组(60.2±23.5)%(P=0.01).IVUS检查显示,两组支架内面积相似,均未见血栓形成.对照组内弹力膜面积较实验组明显减小(P=0.021),而新生内膜面积明显增大(P=0.004).术后处死动物组织形态学检查显示两组血管损伤评分和支架内面积相近(P>0.05),均无明显的炎症反应,但实验组管腔面积[(4.34±0.93)mm2]较对照组[(1.29±1.02)mm2]明显增加(P=0.011),新生内膜面积[(1.51±0.45)mm2]较对照组[(4.60±1.39)mm2]明显减少(P=0.004).组织病理学检查提示所有支架置入节段均完全内皮化,实验组增殖细胞核抗原染色阳性细胞核明显减少,凋亡细胞较对照组增多.结论 川芎嗪药物涂层支架能有效抑制血管内膜增殖及血栓形成,减少支架内再狭窄.     

Determination of adequate coronary stent expansion using StentBoost, a novel fluoroscopic image processing technique.

OBJECTIVE: We tested the hypothesis that the use of motion-corrected fluoroscopic images results in enhanced coronary stent visualization and improved detection of inadequate stent expansion. BACKGROUND: Intravascular ultrasound (IVUS) more accurately detects inadequate stent expansion when compared with coronary angiography. Stent under-expansion is associated with stent restenosis and thrombosis. Developing a technique to improve fluoroscopic-based assessment of stent expansion is desirable. METHODS: We analyzed measurements of 48 coronary stents implanted in 30 patients using quantitative coronary angiography (QCA), IVUS, and StentBoost (SB), a novel fluoroscopic image processing technique. Correlations of stent diameter between the modalities were determined. Using established IVUS criteria for adequate stent deployment, we assessed the diagnostic test characteristics of SB to detect inadequate stent expansion. RESULTS: Correlations of minimum stent diameter were highest between IVUS and SB (r=0.75; P<0.0001) when compared with QCA and IVUS (r=0.65; P<0.0001), and QCA and SB (r=0.49; P=0.0004). IVUS and SB demonstrated a small difference in minimum stent diameter, 0.043 mm (95% CI: 0.146-0.061 mm). The correlation between IVUS and SB was lower for vessels with intimal calcification (r=0.57; P=0.002) when compared with vessels with deeper calcification (r=0.84; P<0.0001). A SB minimum diameter of <2.5 mm predicted inadequate stent expansion by IVUS with 88% sensitivity, 70% specificity, and a positive likelihood ratio of 2.9. CONCLUSIONS: SB had superior correlations for stent expansion measured by IVUS when compared with QCA. A minimum stent diameter by SB measurement<2.5 mm is associated with inadequate stent expansion using IVUS criteria.     

Stent boost enhancement compared to intravascular ultrasound in the evaluation of stent expansion in elective percutaneous coronary interventions

Background

Stent underexpansion is a major risk factor for in-stent restenosis and acute in-stent thrombosis¹Intravascular ultrasound (IVUS) is one of the standards for detection of stent underexpansion (de Feyter et al. 1999; Mintz et al., 2001). StentBoost (SB) enhancement allows an improved angiographic visualization of the stent (Koolen et al., 2005).

国产与进口西罗莫司洗脱支架置入后血管内超声随访的对比

目的 利用血管内超声对比观察国产与进口西罗莫司洗脱支架对冠心病患者支架术后新生内膜增生的抑制作用.方法 2003年5月至2007年3月,对215例冠心病患者(317处病变)置入西罗莫司洗脱支架,并在术后1年行冠状动脉造影和血管内超声(IVUS)检查.其中Firebird组108例患者(147处病变)置入国产西罗莫司洗脱支架(Firebird支架),Cypher组107例患者(138处病变)置入进121西罗莫司洗脱支架(Cypher支架).结果 两组患者一般临床情况差异无统计学意义.两组靶病变部位、病变长度、狭窄程度及病变类型差异均无统计学意义,但Firebird组术后最小管腔直径大于Cypher组[(2.88±0.43)mm比(2.78±0.33)mm,P＜0.05].随访定量冠状动脉造影分析显示,Firebird组与Cypher组支架内晚期管腔丢失[(0.17±0.29)mm比(0.16±0.27)mm,P＞0.05]和节段内晚期管腔丢失[(0.18±0.36)mm比(0.20±0.32)mm,P＞0.05]差异均无统计学意义.IVUS分析显示,与Cypher组比较,尽管Firebird组支架面积[(6.99±2.25)mm~2比(6.46±1.71)mm~2,P＜0.05]、管腔面积[(6.89±2.30)nm~2比(6.36±1.73)mm~2,P＜0.05]、支架体积[(162.5±68.9)mm~3比(140.8±57.9)mm~3,P＜0.01]、管腔体积[(160.4±69.5)mm~3比(138.6±57.6)mm~3,P＜0.01]及最小支架面积[(5.40±1.85)mm~2比(4.92±1.43)mm~2,P＜0.05]均较大,但两组的内膜增生容积[(2.09±5.46)mm~3比(2.23±6.50)mm~3,P＞0.05]和内膜增生容积百分数[(1.68±5.84)%比(1.59±4.10)%,P＞0.05]差异均无统计学意义.结论 Firebird支架置人后再狭窄的发生率较低,抑制内膜增生作用与Cypher支架相似.     

Comparison of intravascular ultrasound, quantitative coronary angiography, and dual-source 64-slice computed tomography in the preprocedural assessment of significant saphenous vein graft lesions

The correlation between cardiac computed tomographic (CT) and intravascular ultrasound (IVUS) assessment of saphenous vein graft (SVG) lesions has not been studied. The aim of this study was to evaluate the accuracy of dual-source computed tomography in quantitative assessment of significant SVG lesions scheduled for percutaneous coronary intervention (PCI). Preintervention dual-source CT (DSCT) scans were performed in consecutive patients before PCI of the SVG lesion. All subjects underwent IVUS examination of the target lesion before stent implantation. Lesion characteristics were described using dual-source computed tomography, quantitative coronary angiography, IVUS, and visual estimation. Luminal areas and diameters, lesion lengths, and DSCT suggested stent dimensions were compared. Twenty-two SVG lesions were assessed in 22 patients. Minimal lumen area measured by IVUS was larger than by dual-source computed tomography (3.5 ± 1.2 vs 3.0 ± 1.2 mm(2), p = 0.04), although there was close correlation between measurements (R = 0.7, p = 0.007). Proximal and distal reference lumen diameters by IVUS and dual-source computed tomography were similar (3.3 ± 0.4 vs 3.4 ± 0.6 mm, p = 0.5, and 3.4 ± 0.6 vs 3.5 ± 0.6 mm, p = 0.4, respectively) and were well correlated (R = 0.85, p <0.0001, and R = 0.81, p <0.0001, respectively). Lesion length by IVUS averaged 18.3 ± 6.1 versus 17.6 ± 5.3 mm by dual-source computed tomography (p = 0.1). There was good correlation between mean reference lumen diameter by dual-source computed tomography and diameter of the implanted stent (R = 0.84, p = 0.0009) and a very good correlation between stent length and lesion length as assessed by dual-source computed tomography (R = 0.9, p <0.0001). In conclusion, DSCT measurements in SVGs correlate with IVUS so that DSCT scan data before PCI of an SVG lesion may be helpful in stent size selection.     

Mechanism of cutting balloon angioplasty for in-stent restenosis: an intravascular ultrasound study.

We investigated by intravascular ultrasound (IVUS) the mechanism of action of cutting balloon (CB) angioplasty in patients with in-stent restenosis. Seventy-one consecutive restenotic lesions of 66 patients were studied by quantitative coronary angiography (QCA) and IVUS before, immediately after, and, in 20 cases, at 24-hr time interval after CB. CB was selected according to 1:1 CB-to-stent ratio and inflated at 8 atm for 60-90 sec. Both IVUS planar and volumetric (Simpson's rule, 25 patients) analysis were carried out. IVUS measurements included external elastic membrane area (EEMA), stent area (SA), minimal lumen area (MLA), and restenosis area (RA). Following CB, QCA analysis showed increase of minimal lumen diameter (1.17 +/- 0.46 vs. 2.45 +/- 0.51 mm; P < 0.0001) and decrease of diameter stenosis (64% +/- 13% vs. 21% +/- 9%; P < 0.0001). IVUS measurements showed a significant increase of MLA (2.18 +/- 0.80 vs. 7.31 +/- 1.8 mm(2); P < 0.0001), SA (9.62 +/- 2.6 vs. 10.7 +/- 2.75 mm(2); P < 0.0001), and EEMA (17.27 +/- 5 vs. 18.1 +/- 5 mm(2); P < 0.0001) and a decrease of RA (7.43 +/- 2.63 vs. 3.45 +/- 1.39 mm(2); P < 0.0001). No significant change was observed in the original plaque + media area (7.65 +/- 3 vs. 7.38 +/- 2.9 mm(2); P = NS). Thus, of the total lumen enlargement (5.13 +/- 1.85 mm(2)), 23% was the result of increase in mean SA, whereas 77% was the result of a decrease in mean RA. These changes were associated with a 5% increase in EEMA. IVUS volumetric changes paralleled planar variations. Angiographic and IVUS changes were well maintained at 24 hr. CB enlarges coronary lumen mainly by in-stent tissue reduction associated with a moderate degree of additional stent expansion. Favorable QCA and IVUS acute results are maintained at 24 hr.     

Safety and utility of intravascular ultrasound-guided carotid artery stenting.

Intravascular ultrasound (IVUS) is useful in evaluating coronary stent deployment. The aim of this study was to assess the safety and utility of IVUS in carotid artery stenting (CAS). Ninety-eight consecutive high-risk patients (107 arteries) underwent CAS. IVUS was performed prior to predilatation in 87 of the 107 vessels and in all 107 following stent deployment when an optimal angiographic appearance was obtained. Quantitative carotid angiography (QCA) and IVUS analysis were performed offline. Procedural success was 97%. Combined stroke or death at 30 days was 5.6%. IVUS measurements of the minimum lumen diameter (MLD) of the distal internal carotid artery (ICA) reference segment were similar to QCA (4.60 +/- 0.74 vs. 4.74 +/- 0.71 mm; P = 0.21). The ICA stent MLD was significantly smaller by IVUS compared to QCA (3.65 +/- 0.68 vs. 4.31 +/- 0.76 mm; P < 0.001). IVUS detected stent malapposition in 11%. IVUS findings, after an optimal angiographic result, necessitated additional treatment in 9% of procedures. Calcium was detected in more arteries with IVUS than angiography (61% vs. 46%; P < 0.05). Arteries with superficial lesion calcification subtending three or four quadrants by IVUS had a 31% incidence of stroke compared with a 1% incidence in arteries without severe superficial calcium (P < 0.001). We found IVUS imaging in CAS to be safe even prior to plaque dilatation. IVUS provides a more accurate assessment of stent dimensions, expansion, and apposition than angiography. Severe calcification by IVUS was associated with a higher risk of stroke.     

Revisiting late loss and neointimal volumetric measurements in a drug-eluting stent trial: analysis from the SPIRIT FIRST trial.

This study was conducted to reevaluate the significance of angiographic late loss and to assess the agreement between new proposed neointimal volumetric measurements derived from quantitative coronary angiography (QCA) and standard intravascular ultrasound (IVUS)-based parameters. Neointimal volumetric measurements may better estimate the magnitude of neointimal growth after stenting than late loss. In 56 in-stent segments (27, everolimus; 29, bare metal) in the SPIRIT FIRST study, we compared QCA measures with the corresponding IVUS parameters. Two IVUS-late loss models were derived from minimal luminal diameter (MLD) using either a circular model or a so-called projected MLD. QCA-neointimal volume was calculated as follows: stent volume (mean area of the stented segment x stent length) at post procedure - lumen volume (mean area of the stented segment x stent length) at follow-up (the stent length either from nominal stent length or the length measured by QCA). Videodensitometric neointimal volume was also evaluated. Each of the three neointimal volume and percentage volume obstruction by QCA showed significant correlation with the corresponding IVUS parameters (r = 0.557-0.594, P < 0.0001), albeit with a broad range of limits of agreement. Late loss and volumetric measurements by QCA had a broader range of standard deviation than those by IVUS. QCA-volumetric measurements successfully confirmed the efficacy of everolimus-eluting stents over bare metal stents (P < 0.05). Our proposed QCA volumetric measurements may be a practical surrogate for IVUS measurements and a discriminant methodological approach for assessment of treatment effects of drug-eluting stents.     

Quantitative measurements of in-stent restenosis: A comparison between quantitative coronary ultrasound and quantitative coronary angiography.

While quantitative coronary angiography (QCA) remains the standard used to assess new interventional therapies, intracoronary ultrasound (ICUS) is gaining interest. The aim of the study was to determine the relationship between QCA and quantitative coronary ultrasound (QCU) measurements after stenting. Sixty-two consecutive patients with both QCA and QCU analysis after stent implantation were included in the study. The mean luminal diameter (QCU vs. QCA) were 2.74 +/- 0.46 mm and 2.41 +/- 0.49 mm (P < 0.0001), the minimal luminal diameter (MLD) 2.08 +/- 0.44 mm and 1.62 +/- 0.42 mm (P < 0. 0001), and the projected QCU MLD 1.90 +/- 0.42 mm (P < 0.0001 with respect to QCA). Percentage obstruction diameter (QCU vs. QCA) were 41.53% +/- 10.78% and 43.15% +/- 12.72% (P = NS). The stent diameter (QCU vs. QCA) were 3.54 +/- 0.65 mm and 3.80 +/- 0.37 mm (P = 0. 0004). Stent length measured by QCU were longer at 31.11 +/- 13.54 mm against 28.63 +/- 12.75 mm, P < 0.0001 with respect to QCA. In conclusion, while QCA and QCU appear to be comparable tools for measuring corrected stent diameters and stent lengths, smaller luminal diameters were found using QCA. This is of particular relevance to quantitative studies addressing absolute changes in vascular or luminal diameters. Cathet. Cardiovasc. Intervent. 48:133-142, 1999.