頚動脈ステント留置術におけるvirtual histology IVUSを用いた頚動脈プラークと再狭窄病変の評価

抄録

Objective : To ensure the safety of CAS (carotid artery stenting), it is important to clarify the characteristics of the plaque before starting the procedure. and also the characteristics of restenotic lesions occurring in the long-term. We therefore analyzed the suitability and efficacy of virtual histology rvus (VH-IVUS)for assessment of carotid plaque before CAS and follow-up after CAS.
Methods : A Volcano Eagle Eye Gold IVUS catheter and the Volcano IVG3 Oracle Imaging System were used. We performed pre-CAS VH-IVUS in 20 cases and follow-up VH-IUVS in 15 cases.
Results : The results of evaluation by VH-IVUS were proven to be effective, and although the technique is invasive, it yields adequate information on plaque composition (accurately diagnosing calcified and fibro-lipidic tissue)by color mapping, as well as offering excellent reproducibility and objectivity. Also, the ratio of each component in the entire lesion was quantitatively appreciable. We found that the amount of debris tended to be minimal when the fibrous component accounted for 60% or more of the entire plaque. By follow-up VH-IVUS, we found that the lesions were of a fibrotic neo-intimal hyperplastic nature, suggesting that lesions containing a large fibro-fatty component have an increased risk for progression to restenosis.
Conclusions : VH-IVUS that yields highly reproducible and objective results is an effective diagnostic method that helps to anticipate stenotic progression by providing information on the characteristics of the lesions at post:-:CAS follow-up.