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.