Peter B. Samuels Award. Restenosis after percutaneous transluminal angioplasty.

Autor: Ramaswami G; Irvine Laboratory for Cardiovascular Investigation and Research, Imperial College School of Medicine at St. Mary's, London, United Kingdom., Dhanjil S, Nicolaides AN, Griffin M, Al-Kutoubi A, Tegos T, Wilkins R, Lewis J, Boolell M, Davies M
Jazyk: angličtina
Zdroj: American journal of surgery [Am J Surg] 1998 Aug; Vol. 176 (2), pp. 102-8.
DOI: 10.1016/s0002-9610(98)00134-2
Abstrakt: Background: Determine the feasibility of studying the natural history of the atherosclerotic plaque following percutaneous transluminal angioplasty (PTA), using duplex scanning.
Methods: Twenty-three patients with 40 stenoses (>70% and <5 cm in length) in the iliac and femoro-popliteal segments were studied by duplex scanning before PTA, on day 1, weekly for 8 weeks, and at 3 months, 6 months, and 1 year. The following measurements were made: thickness of the plaque, minimal lumen diameter (MLD), and peak systolic velocity ratio (PSVR). A PSVR >2.0 was used to indicate >50% lumen diameter reduction.
Results: Thirty stenoses were available for measurement and analysis. Mean reduction in plaque thickness after angioplasty was greater in echolucent plaques (2.33 +/- 0.9 mm) than echogenic plaques (0.83 +/- 0.6 mm; P < 0.0001). Successful angioplasty (PSVR <2.0) and increase in MLD in echolucent plaques was the result of plaque compression; in echogenic plaques, of wall dilatation. The incidence of restenosis (PSVR >2.0) at 6 months was 12 of 30 (40%) remaining unchanged at 1 year; of the lesions that restenosed, 33% recurred before week 8 and the remainder between weeks 8 and 24, suggesting different mechanisms. During follow-up, all plaques showed "growth"; <2 mm in 17 (57%; group A) and >2 mm in the remaining 13 (43%; group B). The incidence of restenosis (PSVR >2.0) was 4 of 17 (23%) in group A and 8 of 13 (61%) in group B (P <0.05).
Conclusion: Duplex scanning provides valuable information on both luminal diameter and plaque thickness; it may be used to study the natural history of plaques following angioplasty and also the effects of therapeutic agents aimed at reducing restenosis.
Databáze: MEDLINE
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