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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C. von Birgelen, E. A. de Vrey, G. S. Mintz, A. Nicosia, N. Bruining, W. Li, C. J. Slager, J. R. T. C. Roelandt, P. W. Serruys, and P. J. de Feyter ECG-Gated Three-dimensional Intravascular Ultrasound : Feasibility and Reproducibility of the Automated Analysis of Coronary Lumen and Atherosclerotic Plaque Dimensions in Humans Circulation, November 4, 1997; 96(9): 2944 - 2952. [Abstract] [Full Text]
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R. Mehran, G. S. Mintz, L. F. Satler, A. D. Pichard, K. M. Kent, T. A. Bucher, J. J. Popma, and M. B. Leon Treatment of In-Stent Restenosis With Excimer Laser Coronary Angioplasty : Mechanisms and Results Compared With PTCA Alone Circulation, October 7, 1997; 96(7): 2183 - 2189. [Abstract] [Full Text]
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A. Schmermund, D. Baumgart, G. Gorge, R. Seibel, D. Gronemeyer, J. Ge, M. Haude, J. Rumberger, and R. Erbel Coronary Artery Calcium in Acute Coronary Syndromes : A Comparative Study of Electron-Beam Computed Tomography, Coronary Angiography, and Intracoronary Ultrasound in Survivors of Acute Myocardial Infarction and Unstable Angina Circulation, September 2, 1997; 96(5): 1461 - 1469. [Abstract] [Full Text]
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H. Berglund, H. Luo, T. Nishioka, M. C. Fishbein, N. L. Eigler, S. W. Tabak, and R. J. Siegel Highly Localized Arterial Remodeling in Patients With Coronary Atherosclerosis : An Intravascular Ultrasound Study Circulation, September 2, 1997; 96(5): 1470 - 1476. [Abstract] [Full Text]
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Y. Ozaki, A. G. Violaris, T. Kobayashi, D. Keane, E. Camenzind, C. Di Mario, P. de Feyter, J. R. T. C. Roelandt, and P. W. Serruys Comparison of Coronary Luminal Quantification Obtained From Intracoronary Ultrasound and Both Geometric and Videodensitometric Quantitative Angiography Before and After Balloon Angioplasty and Directional Atherectomy Circulation, July 15, 1997; 96(2): 491 - 499. [Abstract] [Full Text]
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 J. L. Houghton, V. E. Smith, D. S. Strogatz, N. L. Henches, W. M. Breisblatt, and A. A. Carr Effect of African-American Race and Hypertensive Left Ventricular Hypertrophy on Coronary Vascular Reactivity and Endothelial Function Hypertension, March 1, 1997; 29(3): 706 - 714. [Abstract] [Full Text]
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H. Mudra, E. Regar, V. Klauss, F. Werner, K.-H. Henneke, E. Sbarouni, and K. Theisen Serial Follow-up After Optimized Ultrasound-Guided Deployment of Palmaz-Schatz Stents: In-Stent Neointimal Proliferation Without Significant Reference Segment Response Circulation, January 21, 1997; 95(2): 363 - 370. [Abstract] [Full Text]
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H. Berglund, H. Luo, T. Nishioka, N. L. Eigler, C.-J. Kim, S. W. Tabak, and R. J. Siegel Preserved Vasodilatory Response to Nitroglycerin in Saphenous Vein Bypass Grafts Circulation, December 1, 1996; 94(11): 2871 - 2876. [Abstract] [Full Text]
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M. J. Davies Stability and Instability: Two Faces of Coronary Atherosclerosis: The Paul Dudley White Lecture 1995 Circulation, October 15, 1996; 94(8): 2013 - 2020. [Full Text]
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J. Escaned, J. Baptista, C. Di Mario, J. Haase, Y. Ozaki, D. T. Linker, P. J. de Feyter, J. R.T.C. Roelandt, and P. W. Serruys Significance of Automated Stenosis Detection During Quantitative Angiography: Insights Gained From Intracoronary Ultrasound Imaging Circulation, September 1, 1996; 94(5): 966 - 972. [Abstract] [Full Text]
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L. Wexler, B. Brundage, J. Crouse, R. Detrano, V. Fuster, J. Maddahi, J. Rumberger, W. Stanford, R. White, and K. Taubert Coronary Artery Calcification: Pathophysiology, Epidemiology, Imaging Methods, and Clinical Implications: A Statement for Health Professionals From the American Heart Association Circulation, September 1, 1996; 94(5): 1175 - 1192. [Full Text]
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Y. Nakamura, H. Takemori, K. Shiraishi, I. Inoki, M. Sakagami, A. Shimakura, K. Usuda, K. Kubota, S. Takata, and K.-i. Kobayashi Compensatory Enlargement of Angiographically Normal Coronary Segments in Patients with Coronary Artery Disease: In Vivo Documentation Using Intravascular Ultrasound Angiology, August 1, 1996; 47(8): 775 - 781. [Abstract] [PDF]
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G. S. Mintz, J. J. Popma, A. D. Pichard, K. M. Kent, L. F. Satler, Y. Chien Chuang, R. A. DeFalco, and M. B. Leon Limitations of Angiography in the Assessment of Plaque Distribution in Coronary Artery Disease : A Systematic Study of Target Lesion Eccentricity in 1446 Lesions Circulation, March 1, 1996; 93(5): 924 - 931. [Abstract] [Full Text]
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G. S. Mintz, J. A. Kovach, S. P. Javier, A. D. Pichard, K. M. Kent, J. J. Popma, L. F. Salter, and M. B. Leon Mechanisms of Lumen Enlargement After Excimer Laser Coronary Angioplasty : An Intravascular Ultrasound Study Circulation, December 15, 1995; 92(12): 3408 - 3414. [Abstract] [Full Text]
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N. H.J. Pijls, B. Van Gelder, P. Van der Voort, K. Peels, F. A.L.E. Bracke, H. J.R.M. Bonnier, and M. I.H. El Gamal Fractional Flow Reserve : A Useful Index to Evaluate the Influence of an Epicardial Coronary Stenosis on Myocardial Blood Flow Circulation, December 1, 1995; 92(11): 3183 - 3193. [Abstract] [Full Text]
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Y. Ozaki, D. Keane, and P. W. Serruys Progression and Regression of Coronary Stenosis in the Long-term Follow-up of Vasospastic Angina Circulation, November 1, 1995; 92(9): 2446 - 2456. [Abstract] [Full Text]
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V. Schachinger and A. M. Zeiher Quantitative Assessment of Coronary Vasoreactivity in Humans In Vivo : Importance of Baseline Vasomotor Tone in Atherosclerosis Circulation, October 15, 1995; 92(8): 2087 - 2094. [Abstract] [Full Text]
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P. J. de Feyter, Y. Ozaki, J. Baptista, J. Escaned, C. Di Mario, P. P.T. de Jaegere, P. W. Serruys, and J. R.T.C. Roelandt Ischemia-Related Lesion Characteristics in Patients With Stable or Unstable Angina : A Study With Intracoronary Angioscopy and Ultrasound Circulation, September 15, 1995; 92(6): 1408 - 1413. [Abstract] [Full Text]
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H. C. Stary, A. B. Chandler, R. E. Dinsmore, V. Fuster, S. Glagov, W. Insull Jr, M. E. Rosenfeld, C. J. Schwartz, W. D. Wagner, and R. W. Wissler A Definition of Advanced Types of Atherosclerotic Lesions and a Histological Classification of Atherosclerosis : A Report From the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association Arterioscler Thromb Vasc Biol, September 1, 1995; 15(9): 1512 - 1531. [Abstract] [Full Text]
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H. C. Stary, A. B. Chandler, R. E. Dinsmore, V. Fuster, S. Glagov, W. Insull Jr, M. E. Rosenfeld, C. J. Schwartz, W. D. Wagner, and R. W. Wissler A Definition of Advanced Types of Atherosclerotic Lesions and a Histological Classification of Atherosclerosis : A Report From the Committee on Vascular Lesions of the Council on Arteriosclerosis, American Heart Association Circulation, September 1, 1995; 92(5): 1355 - 1374. [Abstract] [Full Text]
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S. Nakatani, M. Yamagishi, J. Tamai, Y. Goto, T. Umeno, A. Kawaguchi, C. Yutani, and K. Miyatake Assessment of Coronary Artery Distensibility by Intravascular Ultrasound : Application of Simultaneous Measurements of Luminal Area and Pressure Circulation, June 15, 1995; 91(12): 2904 - 2910. [Abstract] [Full Text]
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C. Lu, E. Picano, A. Pingitore, R. Sicari, R. Tongiani, M. Baratto, C. Palmieri, M. Marzilli, and A. L'Abbate Complex Coronary Artery Lesion Morphology Influences Results of Stress Echocardiography Circulation, March 15, 1995; 91(6): 1669 - 1675. [Abstract] [Full Text]
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E. M. Tuzcu, R. E. Hobbs, G. Rincon, C. Bott-Silverman, A. C. De Franco, K. Robinson, P. M. McCarthy, R. W. Stewart, S. Guyer, and S. E. Nissen Occult and Frequent Transmission of Atherosclerotic Coronary Disease With Cardiac Transplantation : Insights From Intravascular Ultrasound Circulation, March 15, 1995; 91(6): 1706 - 1713. [Abstract] [Full Text]
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A. Itoh, S. Miyazaki, H. Nonogi, S. Daikoku, and K. Haze Angioscopic Prediction of Successful Dilatation and of Restenosis in Percutaneous Transluminal Coronary Angioplasty : Significance of Yellow Plaque Circulation, March 1, 1995; 91(5): 1389 - 1396. [Abstract] [Full Text]
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D. Hausmann, R. Erbel, M.-J. Alibelli-Chemarin, W. Boksch, E. Caracciolo, J. M. Cohn, S. C. Culp, W. G. Daniel, I. De Scheerder, C. DiMario, et al. The Safety of Intracoronary Ultrasound : A Multicenter Survey of 2207 Examinations Circulation, February 1, 1995; 91(3): 623 - 630. [Abstract] [Full Text]
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S. H. Duda, M. Wehrmann, B. Erdtmann, P. E. Huppert, and C. D. Claussen Intravascular Ultrasound: Value of Electronic and Mechanical Devices for Quantifying Mild to Moderate Atherosclerosis Angiology, July 1, 1994; 45(7): 597 - 603. [Abstract] [PDF]
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