What Degree Intravascular ultrasonography in Coronary Atherosclerosis Meet our Expectations

Öz

Coronary artery disease and acute coronary syndromes are a leading cause of mortality. Intravascular ultrasonography (IVUS) supplies more accurate information about plaque load and composition than coronary angiography. Especially, IVUS is a promising modality in the determination of vulnerable plaque. However, plaque burden and volumetric calculation of coronary atherosclerosis are determined by IVUS. Progression and/or regression of coronary atherosclerosis can be evaluated with these quantitative data. At the same time, the effects of potentially anti-atherosclerotic drugs on the coronary atherosclerosis can be measured with serial volumetric analysis. ©2006, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

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Koroner Aterosklerozun Görüntülenmesinde İntravasküler Ultrasonografi Beklentilerimizin Ne Kadarını Karşılıyor

Öz

Koroner arter hastalığı akut koroner sendrom ve bunun yol açtığı hayatı tehdit eden komplikasyonlar nedeniyle hala önemini korumaktadır. Koroner aterosklerozun görüntülenmesinde sıklıkla kullanılan anjiyografi damar lümenini gösteren bir yöntemdir. Damar içi ultrasonografi lümenin yanı sıra damar duvarını ve aterosklerotik plağı da göstermektedir. IVUS’ un kullanıma girmesi ile lümen alanın hesaplanması, anjiyografik olarak darlık ciddiyetine karar verilemeyen plakların değerlendirilmesi, stent yerleştirilmesinde yeterli genişletmenin sağlanması konularında önemli gelişmeler sağlanmıştır. Kalp nakli hastalarında meydana gelen vaskülopatiyi anjiyografinin erken evrelerde tanıması güçtür. IVUS ile transplant vaskülopatisinin erken tanısı mümkün olmaktadır. Hassas plakların tespiti için IVUS sinyallerini daha ileri yöntemlerle değerlendirebilen radyofrekans analizi ve elastogram gelecekte önemi artacak yöntemlerdendir. Bunun yanı sıra ateroskleroz yaygınlığının tespiti ve koroner aterosklerozun hacimsel olarak hesaplanabilmesi IVUS’un bize sağladığı nicel verilerin başında gelir. Bu nicel veriler sayesinde koroner aterosklerozdaki ilerlemeler veya gerilemeler seri IVUS takipleriyle tespit edilebilir. Antiaterosklertoik ilaçların etkinliği de IVUS çalışmalarıyla bu sayede tespit edilmektedir.©2006, Fırat Üniversitesi, Tıp Fakültesi

Anahtar Kelimeler

• İntravasküler, ultrason, plak, ateroskleroz, koroner arter hasralığı

Kaynakça

1. Tardif JC, Pandian NG. Intravascular ultrasound imaging in peripheral damarial and coronary damary disease. Curr Opin Cardiol 1994; 9: 627-33.
2. Haasdai D, Behar S, Wallentin L, et al. A prospective survey of the characteristics, treatment and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin; Euro Heart Survey of Acute Coronary Syndromes (Euro Heart Survey ACS). Eur Heart J 2002; 23: 1190-201.
3. Hausmann D, Erbel R, Alibelli-Chemarin MJ, et al. The safety of intracoronary ultrasound: amulticnter survey of 2207 examinations. Circulation 1995; 91: 623-30.
4. Pinto FJ, St Goar F, Gao SZ, et al. Immediate and one year safety of intracoronary ultrasonic imaging: evaluation with serial quantitative angiography. Circulation 1993; 88: 1709-14.
5. Ramasubbu K, Schoenhagen P, Balghith MA, et al. Repeated intravascular ultrasound imaging in cardiac transplant recipients does not accelerate transplant coronary artery disease. J Am Coll Cardiol 2003; 41: 1739-43.
6. Mintz GS, Pichard AD, Kovach JA, Kent KM, Satler LF, Javier SP et al. Impact of preintervention intravascular ultrasound imaging on transcatheter treatment strategies in coronary artery disease. Am J Cardiol 1994; 73: 423-30.
7. Nakamura S, Colombo A, Gaglione A, Almagor Y, Goldberg SL, Maiello L et al. Intracoronary ultrasound observations during stent implantation. Circulation 1994; 89: 2026-34.
8. Tobis JM, Mahon DJ, Goldberg SL, et al. Lessons from intravascular ultrasonography: observations during interventional angioplasty procedures. J Clin Ultrasound 1993; 21: 598-607.

9. Kasaoka S, Tobis JM, Akiyama T, et al. Angiographic and intravascular ultrasound predictors of in-stent restenosis. J Am Coll Cardiol 1998; 32: 1630-5.
10. Moussa I, Di Mario C, Reimers B, et al. Subacute stent trombosis in the era of intravascular ultrasound-guided coronary stenting withouth anticoagulation : frequency, predictors and clinical outcome. J Am Coll Cardiol 1997; 29: 6-12.
11. Abizaid AS, Mintz GS, Mehran R, et al: Long-term follow-up after percutaneous transluminal coronary angioplasty was not performed based on intravascular ultrasound findings: importance of lumen dimensions. Circulation 1999; 100: 256-61.
12. Tuzcu EM, Kapadia SR, Sachar R, et al. Intravascular ultrasound evedince of angiographically silent progression in coronary atherosclerosis predicts lon-term morbidity and mortality after cardiac transplantation.
13. Glagov S, Weisenberg E, Zarins CK, et al. Compensatory enlargement of human atherosclerotic coronary damaries. N Eng J Med 1987; 316: 1371-5.
14. Ito K, Yamagishi M, Yaasumura Y, et al. Impact of coronary damary remodeling on misinterpreration of angiographic disease eccentricity: evidence from intravascular ultrasound. Int J Cardiol 1999; 70: 275-82.
15. Sipahi I, Tuzcu EM, Schoenhagen P, Nicholls SJ, Kapadia S, Nissen SE: Paradoxical Increase in Lumen Size During Progres- sion of Coronary Atherosclerosis: Observations from The REVERSAL Trial. Atherosclerosis 2006 (in press)
16. Sipahi I, Tuzcu EM, Schoenhagen P, Nicholls SJ, Crowe T, Kapadia S, Nissen SE: Discordance between Static and Serial Assessments of Arterial Remodeling: An Intravascular Ultrasound Analysis from the Reversal of Atherosclerosis with Aggressive Lipid Lowering (REVERSAL) Trial. Am Heart J 2006 (in press)
17. Schoenhagen P, Ziada KM, Kapadia SR, et al. Extent and direction of damarial remodeling in stable and unstable coronary syndromes. Circulation 2000; 101: 598-603.
18. Schoenhagen P, Vince DG, Ziada KM, et al. Relation of matrix- metalloproteinase 3 found in coronary lesion samples retrieved by directional coronary atherectomy to intravascular ultrasound observations on coronary remodeling. Am J Cardiol 2002; 89: 1354-9.
19. Mintz GS, Painter JA, Pichard AD, et al. Atherosclerosis in angiographically “normal” coronary damary reference segments: an intravascular ultrasound study with clinical correlations. J Am Coll Cardiol 1995; 25: 1479-85.
20. Nair A, Kuban BD, Tuzcu EM, et al. Coronary plaque classification with intravascular ultrasound radiofrequency data analysis. Circulation 2002; 106: 2200-6.
21. Schaar JA, De Korte CL, Mastik F, et al. Characterizing vulnerable plaque features with intravascular elastography. Circulation 2003;108:2636-41
22. Jukema JW, Bruschke AV, van Boven AJ, et al. Effects of lipid lowering by pravastatin on progression and regression of coronary damary disease in symptomatic men with normal to moderately elevated serum cholesterol levels. The Regression Growth Evaluation Statin Study (REGRESS). Circulation 1995; 91: 2528-40.
23. Nissen SE, Tuzcu EM, Schoenhagen P, et al. REVERSAL Investigators. Effect of intensive compared with moderate lipid- lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004; 291: 1071-80.
24. Cannon CP, Braunwald E, McCabe CH, et al. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Eng J Med 2004; 350: 1495-504.
25. Nissen SE, Tuzcu EM, Libby P, et al. CAMELOT Investigaters. Effects of antihypertensive agents on cardiovascular events in patients with coronary disease and normal blood pressure: the CAMELOT study: a randomized controlled trial. JAMA 2004; 292: 2217-25. Nissen SE, Tsunoda T, Tuzcu EM, et al. Effect of recombinant ApoA-I Milano on coronary atherosclerosis in patients with acute coronary syndromes: a randomize controlled trial. JAMA 2003; 290: 2292-300.
26. Eisen HJ, Tuzcu EM, Dorent R, et al. Everolimus for the prevention of allograft rejection and vasculapathy in cardiac transplant recipients. N Engl J Med. 2003; 349: 847-58.
27. Kabul Tarihi: 10.02.2006