With intension of noninvasive, quantitative analysis of arteriosclerosis of carotid artery, we design ultrasonic, phase-locked echo tracking system. (Materials and method) Materials are consisted of 169 cases from 3 to 59 years old. Measuring system is shown in Fig. (2). The measured portions are four points along the common carotid artery containing carotid sinus. Fig. (2). We use stiffness parameterβ by Hayashi as a index of elastic property of artery. We can calculate it by following equation. β=ln Pmax/Pmin·D/ΔD, where Pmax is maximum pressure, Pmin is minimum pressure, D is diastolic diameter, and ΔD is the diameter change during the heart cycle. Now we fix the probe softly on the measuring position. The electric pulses are sonified into the body of the object through transducer as 5MHZ ultrasonic pulses. Then pulses reflected from the vessel walls are monitored on A-scope screen. Two tracking gates are set to follow automatically the movement of the echoes corresponding to the wall motion. Such behavior of the wall is recorded by the pen recorder. Fig. (3). Thus giving us the diameter change (ΔD) of the vessel during the heart cycle as well as diastolic diameter (D). Blood pressure are measured on the upper arm. (Result) 1. The each diameter of common carotid artery is almost same along the portions (B, C, D, ) and that of sinus (E) is a little larger than the others. In any portions the diameters are became larger with aging. Fig. (4). 2. We calculate stiffness parameterβ at each portion on common carotid artery in each individuals. Fig. (5), Fig. (6). β is increased with aging in any portions. But under 29 years old, we can find no difference between four portions on carotid artery, and the difference between each individuals is small. Over 30 years old, β is became higher with remarkable difference between four portions. Over 40, β of carotid sinus is became higher pecuriarly than the others (B, C, D, ). We can find this tendency more clearly over 50 years old. 3. The standard deviation of β at carotid sinus over 40 is higher than that of the other portions clearly. We can recognize the appearance of material change in common carotid artery.

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The study examined the progresses of a coronary arterial disease among medical, surgical and PTCA treated groups and compared the long-term results with anti-platelet therapy (trapidil 300mg/day or persantin 75mg+aspyrin 300mg/day) or Ca²⁺ channel blockade (nifedipine 40mg/day) groups. 323 patients with effort angina were studied. These were grouped into Group I (96 patients treated medically), Group 11 (147 patients who underwent CABG) and Group III (84 patients treated with PTCA). Group I was further divided into 3 subgroups; I-B 37 cases who were administered with anti-platelet drug for a long period of time, I-C 21 cases who were administered with Ca²⁺ channel blockade and I-A 38 cases with whom none of the 2 drugs was administered. Group II was likewise divided into 3 subgroups of II-B, anti-platelet administered group, II-C, Ca²⁺ channel blockade administered group and II-A, non-administered group. The observation was conducted in 3 to 60 months (average 12.4 months) after the 1st CAG. Serial CAG were taken in each case. The standard of the progress diagnosis was based on Kramer's criteria. RESULTS & CONCLUSION: 1) Among I-A group patients, progress, non-progress, and regress cases were, 50, 40 and 5%, respectively. 55% of the patients showed progress had the effect within 12 months. The level of progress after this period co-relates to the length of observa-tion period, showing 72% peak in over 2 yrs. Relationship with affected vessels; Progress of the responsible coronary arterial vessel with patients involving single vessel disease showed the highest record. The highest rate was with the cases where the disease progressed to a complete occlusion (type 1). On the other hand, among B and C groups, the rate of progress after 2 yrs remarkably became low (p<0.01). LV function was favorable both with I-B, I-C groups. With II-A group, the rate of progress was high in non-grafted vessels within one to one year and a half period with high ratio of type 1, while with II-B, II-C groups, a difference in progress was observed. Among B group patients progression and regression were 33, and 13% within 12 months. While, among C groups, progression, non-progression, and regression were 35, 44 and 21%. 2) Among Group III, 9 cases or 13% showed recurrence of the initially dilated vessel. Of these, 56% showed a significant progress in initally dilated vessel; however, a good result was observed after the 2nd PTCA. 3) These drugs were considered as preventing the progression of coronary artery disease. It is concluded that for angina pectoris patients, a specific treatment program should be established to prevent the progress of the disease, in addition to a conventional therapeutical program. 4) Synergistic effects of these drugs might be resulted from vascular injury suppression, platelet inhibition, coronary vasodilation, improvement of lipids metabolism as well as improvement of LV performance.

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平均4.1カ月後の確認造影にて再狭窄を認めず,3年以上経過観察後に追跡冠動脈造影を施行し得た症例を対象としPTCA後の自然歴と長期予後について検討を加えた.PTCA施行血管での新規病変発生は2.3%であるのに対し,非施行血管では14.5%と有意(p<0.01)に高く,再狭窄を免れた病変は長期にわたり良好な開存性を有することが確認された.新規病変はacute coronary syndromeや造影上intimal disruptionを認め,粥腫崩壊や血栓形成がcardiac event発生につながる可能性もあり,十分な内科管理が重要と考えられた.

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Comparative study on natural history of coronary atherosclerosis in 83 patients with effort angina between medical and surgical group were designed based on two coronary arteriograms.
The second coronary arteriograms were performed averaged 9 months after the initial angiography. Progression or regression were defined as 6 categories in severity of each coronary artery based on Kramer's criteria.
1) Incidence of progression was found in 50 of all patients with no relation to the age. Especially, the types of that were most frequently recognized as the categories of a) less than 100 to 100%, b) less than 30% to greater than 50%.While, the incidence of regression was found in only 4% with the non-infarcted patients.
2) As for progression in relation to the interval, the peak of that's incidence was recognized as one year later after CABG, however, these incidences were significant within 6 months in both groups.
3) In relation to coronary artery, the incidence of progression was highest in right coronary artery with medical group. On the other hand, that was significantly high in left circumflex coronary artery of the non-grafted vessels surgically.
4) As conclusion, serial coronary arteriograms are very important to evaluate the progressive arterial change or regression in patients with the ischemic heart disease.

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