풍선확장술 직후 시간경과에 따른 혈관의 변화

Abstract

Background : Plaque compression(and/or redistribution) and vessel expansion are important mechanisms of percutaneous coronary balloon angioplasty. We investigated the mechanisms of balloon angioplasty according to plaque characteristics by intravascular ultrasound and assessed the time-sequencing morphometric changes of target vessels after balloon dilation without catheter change using intravascular ultrasound balloon catheter. Methods : We studied balloon angioplasty in 10 patients(eight male, average age of 55.3 years). Quantitative coronary angiography and intravascular ultrasound images were attained at baseline and at timed intervals of Osec, 60sec and 180sec post-balloon angioplasty. The following categories were attained : reference diameter, minimal lumen diameter, cross sectional area (CSA) of lumen(L), external elastic membrane(EEM), and plaque+media(P+M). We also assessed the plaque morphology of target lesions and classified them into two groups according to intravascular ultrasound imaging : a soft plaque group versus a group characterized. by fibrous and/or mildly calcified plaque. Results : The proportion of plaque compression in the total luminal gain was 80% in the soft plaque group and 70% in the other ; the absolute amount of plaque compression was 26.9% in soft plaque and 24.0% in the other group. The time sequencing changes of target lesion EEM CSA of both groups were 14.4±2.9mm², 14.3±3.8mm²(baseline), 15.1±2.5mm², 15.4±3.7 mm²(immediate), 15.0±2.8mm², 14.5±3.9mm²(180sec), those of P+M CSA(target1esion) were 10.4±3.3mm², 10.7±2.4mm² (baseline),7.6±2.7mm², 8.1±2.4mm²(immediate), 7.9±2.9mm², 8.5±3.4mm²(180sec). Target lesion lumen CSA were 4.0±1_lmm², 3.6±2.0mm²(baseline) 7.5 ± 1.1mm², 7.3±3.2 mm²(immediate) 7.1 ± 1.3mm², 6.0± 1.7mm²(180sec) respectively. Conclusions : Plaque compression(and/or redistribution) is the predominant mechanism of luminal gain in both groups. The absolute amounts of P+M CSA changes and time sequencing increments of target lesions were similar in both groups. In the non-soft group, the immediate increment and time sequencing reduction of EEM CSA in target lesions were greater than those of the soft plaque group.