冠脉血管内超声的应用研究

冠状动脉造影（CAG）一直用来作为诊断冠心病的“金标准”。近些年来,随着微型导管超声换能器和声学成像技术的飞速进步,血管内超声（intravascular ultrasound,IVUS）在冠状动脉疾病患者中的应用越来越广泛,而且它的发展与冠状动脉介入治疗的发展是互相平行的,成为冠状动脉疾病临床诊断和介入治疗中具有重要价值的新的“金标准”。     

血管内超声技术研究进展

血管内超声（intravascularultrasound，IVUS）是近年来发展起来的一种新型的超声显像技术，其研究始于60年代[1,2]，直到80年代中期才取得较大进展。它是无创性的超产技术和有创性的心导管技术相结合的一种新的诊断方法。其主要部件导管式探头，系由微型的超声换能器安装于柔软的心导管或导引钢丝头端所构成。IVUS探头分为相控阵探头及机械扫描探头两种基本类型。相控阵探头采用微型多晶体片（多为64片）围绕导管头瑞环状排列（如美国加利福尼亚州的Endosonics），这种环状设计可安放在极小的导管轴上（＜5F），使柔软的导管可以最大限…     

血管内超声在冠脉支架中的应用

血管内超声（ｉｎｔｒａｖａｓｃｕｌａｒｕｌｔｒａｓｏｕｎｄ；ＩＶＵＳ）是利用安装在心导管尖端的微型超声探头从管腔内观察血管形态的一门新技术。ＩＶＵＳ的显像内容：（１）显示管腔形态；ＩＶＵＳ可观察血管横切面上管腔的形态；（２）显示管壁结构；（３）显示斑...     

应用血管内超声诊断心血管疾病

近年来,心脏超声的一个重要分支-血管内超声得到了迅速发展,已成为心血管研究和心血管临床工作中的一个重要手段。本文简介血管内超声的发展历史、血管内超声诊断心血管疾病的原理和临床应用,并对心腔内超声和血管内超声多普勒作一简介。 1血管内超声的历史六十年代初,cieszynski将超声探头置于导管头上,通过外周血管进入狗的心腔,记录到A型超声图。1972年,Born等将超声探头置于9号导管头上,第一次得到二维的超声图象。80年代起,随着经皮穿刺冠状动脉内成形术(PTCA),激光治疗冠状动脉粥样斑块,机械装置去除动脉粥样斑块,冠状动脉内安置移植模等技术的兴起和发展,需对病变冠     

血管内超声成像探头的现状与研究进展

随着现代科学技术的发展,血管成像技术逐渐朝向多样化方向发展,该项技术的不断研发推动着我国针对心血管疾病治疗技术的前行,其中,血管内超声成像探头技术就是通过在导管的前段安装一个微型超声探头从而获取血管内部管腔的横截面图像,该图像在一定程度上可以很好的说明冠状动脉血管内的情况,因此被看作为现阶段心血管疾病最为准确的检验标准之一,基于此,本文通过对血管内超声成像探头技术发展的现状与进展进行分析,找到未来治疗心血管疾病的新出路与新方向。     

血管内超声在脑血管疾病诊治中的研究进展

正血管内超声(intravascular ultrasound,IVUS)是基于导管的超声装置,该技术借助介入放射学方法将超声导管直接置入血管中,可显示血管内影像,检测血管壁性质等,已在心脏与外周血管疾病领域显示出其优势~[1-2],但在脑血管疾病的诊疗领域尚属探索阶段。DSA被认为是脑血管疾病诊断的"金标准",但传统的依靠动脉直径狭窄率来评价颅内外血     

血管内超声在冠状动脉粥样硬化性心脏病诊治中应用

血管内超声(intravascular ultrasound,IVUS)显像技术是将微型化的超声探头通过导管技术送入血管腔内,实时显示血管横截面图像,可观察血管腔和血管壁动脉粥样硬化病变的形态,并可根据病变回声特性判断病变的性质,精确测定血管腔、血管的大小及病变狭窄程度,可用于指导介入治疗。1971年Bom首先发明超声导管,用于心腔和瓣膜成像。20世纪80年代末开始应用于人体冠状动脉,是第一个     

经皮冠状动脉腔内成形术后冠状动脉内超声显像:形态学和定量评价

血管内超声显像能够检出并定量显示血管内治疗的机械效果。本文报告,应用血管内超声导管系统评定经皮冠脉腔内成形术(PTCA)的形态学效果。方法 20MHz的机械探头轴在外径4.8F的导管内转动,转速为600～900rpm。超声晶体的最佳焦距在1.5mm范围,最大穿透深度为 1cm。     

强心甙和心得安对清醒狗缺血心脏的联合作用

心得安能减慢心率和降低心肌收缩力,从而减少心肌需氧量,保护缺血心肌,因而推荐用来治疗急性缺血性心脏病。但是,心得安的心肌抑制作用对心功能是有害的。本文通过对清醒狗缺血心脏的实验,评价哇巴因和心得安联合应用的作用。方法:21只狗,经麻醉手术,在左室内安置微型压力计,冠状动脉左前降支或回旋支安置Doppler超声血流换能器,其远端安置水力闭塞器;左房和主动脉安置Tygon导管。在可能正常、中度和严重缺血区的心肌内置放六对微型超声换能器。用改良的超声“通过时间”(transit-time)长度计测定局部心肌节段长度,并利用超声换能器作为     

心腔内超声在冠心病中的应用

<正>心腔内超声(intracardiac echocardiograph,ICE)是将超声换能器置于心脏导管头端,从心腔内观察心脏结构和功能的新技术,1994年首次被用于射频消融术。近年来其功能不断完善,目前新型相控阵超声导管不仅具有二维显像、M型显像、血流多普勒检测功能,还能进行组织多普勒显像及实时三维动态显像。它能高清晰地显示心脏解剖结构,提供全面的血流动力学和心功能信息,尽管目前临床研究较多关注ICE在     

Clinical indications for intravascular ultrasound imaging

Intravascular ultrasound (IVUS) is a catheter-based imaging modality, which provides high resolution cross-sectional images of the coronary arteries. Unlike angiography, which displays only the opacified luminal silhouette, IVUS permits imaging of both the lumen and vessel wall and allows characterization of the type of the plaque. Although IVUS provides accurate quantitative and qualitative information regarding the lumen and outer vessel wall, it is not routinely used during coronary angiography or in angioplasty procedures because the risk to benefit ratio (additional expense, procedural time, certain degree of risk, and complication versus improvement in the outcome) does not justify routine utilization. Nevertheless, there are situations where IVUS is extremely useful tool both for diagnosis and management so the aim of this review is to summarize the indications for IVUS imaging in the contemporary clinical practice.     

New developments in intravascular ultrasound

Intravascular ultrasound (IVUS) is a dynamic imaging modality that provides real-time in vivo visualization of atherosclerosis and other vascular pathology. The tomographic image presentation of IVUS permits detailed assessment of plaque morphology and its corresponding responses to interventional therapy. IVUS studies have confirmed vascular remodeling in vivo, have proposed a high-pressure stent implantation strategy and have shown two key mechanisms of restenosis after angioplasty: plaque proliferation and vessel shrinkage (negative remodeling). IVUS also provides accurate quantitative information regarding lumen size, vessel size and plaque burden. These observations, essential to achieving improved outcomes, have drastically changed the understanding of atherosclerotic artery disease and interventional procedures. IVUS has matured into an essential complement to daily peripheral and coronary interventional practice and is routinely incorporated as part of the interventional arsenal in the catheterization laboratory. A variety of new imaging techniques are currently being designed and tested. These include combined therapeutic devices, further miniaturization, 3-D applications and tissue characterization. These techniques may evolve to provide increased favorable clinical outcomes and more accurate information of vessel geometry and plaque composition.     

Value of intravascular ultrasound in guiding coronary interventions

There has been great effort to improve clinical outcome in percutaneous treatment for coronary artery disease. Complementary to coronary angiography, intravascular ultrasound (IVUS) provides in vivo tomographic anatomic information, enabling to evaluate from the lumen to the vessel wall. As a result, IVUS has had a pivotal role to understand pathophysiology of coronary artery disease and improve clinical outcome. It provides preprocedural information to evaluate stenosis severity and plaque characteristics and helps with optimal stent deployment, minimizing underexpansion and geographic miss that are the major mechanisms of stent failure. Recently, many large‐scale clinical trials and meta‐analyses with drug‐eluting stents have shown the clinical benefits of IVUS‐guided percutaneous coronary intervention. Some recent studies have also supported the cost‐effectiveness of IVUS‐guided PCI especially in high‐risk patients. This article will discuss the clinical value of IVUS in contemporary practice.     

血管内超声在冠状动脉介入诊治中的运用

目的观察运用血管内超声(Intravascular ultrasound IVUS)测定冠脉病变血管的价值及安全性。方法30例冠心病患者,共46支冠状动脉血管在冠状动脉造影(Coronary angiography CAG)后行IVUS检查。IVUS测量狭窄段血管直径和截面积、斑块性质,与相应部位定量的冠状动脉造影(Quantitative coronary angiographyQCA)的结果比较。结果QCA检出偏心性狭窄25处(54.3%);IVUS检出偏心性狭窄32处(69.6%)(P<0.05)。IVUS发现30处(65.2%)靶血管病变钙化,而CAG检出18处(39.1%)血管病变钙化(P<0.01)。CAG和IVUS检出病变血管直径狭窄率分别为62.15%和74.35%(P<0.01)。46处(100%)靶血管完成IVUS检查,34处血管介入后复查,其中1处IVUS导管无法通过支架,IVUS检出不理想支架释放8处(24.2%)。所有患者随访1个月以上,未发现严重心脏缺血事件。结论IVUS可以准确地识别冠状动脉管腔形态、斑块性质,有助于冠脉介入手术策略的选择,是对CAG的有效补充,IVUS检查本身比较安全。     

不同冠状动脉截段定量冠状动脉造影与血管内超声测值的差异与意义

目的评价定量冠状动脉造影(QCA)与血管内超声(IVUS)在冠心病不同冠状动脉截段参考血管直径的测量差异。方法选择2015年12月至2018年10月在导管室同时行冠状动脉造影及IVUS检查的患者共278例,分别测量不同冠状动脉截段病变血管的参考血管直径,并进行比较,寻找相对简单的公式应用于两者内在联系,并随机选择额外300处病变(280例患者)血管进行验证分析。结果不同冠状动脉截段病变血管的参考血管直径QCA和IVUS测值之间存在显著差异,右冠状动脉直径IVUS测值较QCA测值大,旋支直径IVUS测值较QCA测值小,这种差异在血管远端更明显。通过线性回归分析,QCA测量的不同冠状动脉截段参考血管直径由相应公式推算出IVUS测出的直径,并通过额外300处血管病变测量的数值得到相应验证。结论不同冠状动脉截段定量冠状动脉造影与血管内超声测值之差具有规律性,有助于冠状动脉介入治疗中确定血管直径。     

Clinical Utility of Intravascular Imaging and Physiology in Coronary Artery Disease

Intravascular imaging and physiology techniques and technologies are moving beyond the framework of research to inform clinical decision making. Currently available technologies and techniques include fractional flow reserve; grayscale intravascular ultrasound (IVUS); IVUS radiofrequency tissue characterization; optical coherence tomography, the light analogue of IVUS; and near-infrared spectroscopy that detects lipid within the vessel wall and that has recently been combined with grayscale IVUS in a single catheter as the first combined imaging device. These tools can be used to answer questions that occur during daily practice, including: Is this stenosis significant? Where is the culprit lesion? Is this a vulnerable plaque? What is the likelihood of distal embolization or periprocedural myocardial infarction during stent implantation? How do I optimize acute stent results? Why did thrombosis or restenosis occur in this stent? One of the legacies of coronary angiography is to presume that one technique will answer all of these questions; however, that often has been proved inaccurate in contemporary practice.     

Ten years after introduction of intravascular ultrasound in the catheterization laboratory: tool or toy?

Intravascular ultrasound (IVUS) represents the gold standard in the assessment of atherosclerotic disease. It has deeply affected our understanding of coronary artery disease and therapeutic strategies. We learned that a phenomenon described in pathologic series plays a very important role during life--that of vessel remodeling. The type of remodeling (positive or negative) cannot been assessed by angiography but is clinically relevant for optimal, procedural lumen gain. The modern stent implantation technique with a high balloon to artery ratio and high balloon pressure is the result of the IVUS finding that the majority of stents are not optimally deployed despite appropriate angiographic results. IVUS is essential in the clinical practice for the assessment of ambiguous angiography, left main stem disease, complex lesion and in-stent restenosis. Furthermore, IVUS has become an indispensable research tool in the analysis of new therapeutic strategies such as coronary brachytherapy.     

Clinical Utility of Intravascular Imaging: Past,Present, and Future

Although it is the tool used by most interventional cardiologists to assess the severity of coronary artery disease and guide treatment, coronary angiography has many limitations because it is a shadowgraph, depicting planar projections of the contrast-filled lumen that are often foreshortened rather than imaging the diseased vessel itself. Currently available intravascular imaging technologies include grayscale intravascular ultrasound (IVUS), optical coherence tomography (OCT) (the light analogue of IVUS), and near-infrared spectroscopy that detects lipid within the vessel wall and that has been combined with grayscale IVUS in a single catheter as the first combined imaging device. They provide tomographic or cross-sectional images of the coronary arteries that include the lumen, vessel wall, plaque burden, plaque composition and distribution, and even peri-vascular structures—information promised, but rarely provided angiographically. Extensive literature shows that these tools can be used to answer questions that occur during daily practice as well as improving patient outcomes. Is this stenosis significant? Where is the culprit lesion? What is the anatomy of an unusual or ambiguous angiographic lesion? What is the right stent size and length? What is the likelihood of distal embolization or periprocedural myocardial infarction during stent implantation? Has the intervention been optimized? Why did this stent thrombose or restenose? This review summarizes these uses of intravascular imaging as well as the outcomes data supporting their incorporation into routine clinical practice.     

Intravascular ultrasonography in the evaluation of results of coronary angioplasty and stenting

The main advantage of intravascular ultrasonography (IVUS) over angiography in assessing the effect of coronary interventions is the ability of IVUS to directly visualize the vessel wall. IVUS often reveals a high residual plaque burden after angiographically successful angioplasty, and this can motivate the operator to use additional, more aggressive measures in an attempt to increase lumen dimensions. Studies using IVUS imaging before and after balloon angioplasty have shown that luminal gain after percutaneous transluminal coronary angioplasty (PTCA) results from a combination of plaque reduction and vessel wall stretch. Minimal luminal area and residual area stenosis after PTCA and stent deployment, as measured by IVUS, have been shown to be predictors of restenosis. IVUS studies have pointed to vessel shrinkage, not intimal hyperplasia, as the main mechanism of restenosis after PTCA. IVUS guidance of stent deployment has often revealed inadequate stent expansion despite optimal results on angiography, leading to high-pressure stent deployment with significant additional luminal gain. Restenosis rates may be lower with IVUS-guided stent deployment.     

Accuracy of nonstenotic coronary atherosclerosis assessment by multi-detector computed tomography.

BACKGROUND: The ability to evaluate coronary stenosis using multi-detector computed tomography (MDCT) has been well discussed. In contrast, several studies demonstrated that the plaque burden measured by intravascular ultrasound (IVUS) has a relationship to the risk of cardiovascular events. the accuracy of MDCT was studied to determine plaque and vessel size compared with IVUS. METHODS AND RESULTS: Fifty-six proximal lesions (American College of Cardiology/American Heart Association classification: segment 1, 5, 6) from 33 patients were assessed using MDCT and IVUS. The plaque and vessel area were measured from the cross-sectional image using both MDCT and IVUS. Eight coronary artery lesions with motion artifacts and heavily calcified plaques were excluded from the analysis. The vessel and lumen size evaluated using MDCT were closely correlated with those evaluated by IVUS (R(2)=0.614, 0.750 respectively). Furthermore, there was a strong correlation between percentage plaque area assessed by MDCT and IVUS (R(2)=0.824). CONCLUSION: MDCT can noninvasively quantify coronary atherosclerotic plaque with good correlation compared with IVUS in patients with atherosclerosis.