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Circulation, Vol 84, 1087-1099, Copyright © 1991 by American Heart Association
SE Nissen, JC Gurley, CL Grines, DC Booth, R McClure, M Berk, C Fischer and AN DeMaria
BACKGROUND. Necropsy studies demonstrate that coronary artery disease (CAD)
is frequently complex and eccentric. However, angiography provides only a
silhouette of the vessel lumen. Intravascular ultrasound is a new
tomographic imaging method for evaluation of coronary dimensions and wall
morphology. Few data exist regarding intravascular ultrasound in patients
with CAD, and no data exist for subjects with normal coronaries. METHODS
AND RESULTS. We used a multielement 5.5F, 20-MHz ultrasound catheter to
examine eight normal subjects and 43 patients with CAD. We assessed the
safety of coronary ultrasound and the effect of vessel eccentricity on
comparison of minimum luminal diameter by angiography and ultrasound.
Normal and atherosclerotic wall morphology and stenosis severity were also
evaluated by intravascular ultrasound. The only untoward effect was
transient coronary spasm in five patients. At 33 sites in normal subjects,
the lumen was nearly circular, yielding a close correlation between
angiographic and ultrasonic minimum diameter (r = 0.92). At 90 sites in
patients with CAD, ultrasound demonstrated a concentric cross section;
correlation was also close (r = 0.93). However, at 72 eccentric sites,
correlation was not as close (r = 0.77). For 41 stenoses, correlation
between angiography and ultrasound for area reduction was moderate (r =
0.63). In normal subjects, wall morphology revealed a thin (0.30 mm or
less) intimal leading edge and subadjacent sonolucent zone (0.20 mm or
less). Patients with CAD exhibited increased thickness and echogenicity of
the leading edge, thickened sonolucent zones, and/or attenuation of
ultrasound transmission. CONCLUSIONS. These data establish that
intravascular ultrasound is feasible and safe and yields luminal
measurements that correlate generally with angiography. Differences between
angiographic and ultrasound measures of lumen size in eccentric vessels
probably reflect the dissimilar perspectives of tomographic and silhouette
imaging techniques. Intravascular ultrasound provides detailed images of
normal and abnormal wall morphology not previously possible in vivo.
ARTICLES
Intravascular ultrasound assessment of lumen size and wall morphology in normal subjects and patients with coronary artery disease
Division of Cardiovascular Medicine, University of Kentucky Medical Center, Lexington 40536-0084.
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S. R. Kapadia, S. E. Nissen, K. M. |