Evaluation of vascular injury following percutaneous transluminal coronary angioplasty: a comparison of the accuracy of two- and three-dimensional intracoronary ultrasound imaging.
BACKGROUND
Following percutaneous transluminal coronary angioplasty (PTCA), the extent of vascular injury is underestimated by angiographic assessment. Conventional intracoronary ultrasound (ICUS) imaging provides additional information with regard to the extent of dissections but requires mental reconstruction of consecutive images. Three-dimensional ICUS reconstruction overcomes this limitation and may provide more accurate assessment of the extent of vascular injury. This study compares conventional two-dimensional ICUS imaging to combined two- and three-dimensional ICUS information in the assessment of vascular injury following PTCA.


METHODS
Atherosclerotic, human coronary arteries (n=24) were studied in a specially constructed flow system. Balloon dilatation of significant stenoses was performed followed by assessment using two- and three-dimensional ICUS imaging methods. Treated arteries were submitted for histological assessment after pressure fixation. Dissection depth and length measurements were made from obtained images and compared to histomorphometric assessments.


RESULTS
Of the 20 arterial segments confirmed histologically to contain dissection, 11 (55%) and 18 (90%) were identified by two-dimensional ICUS and combined two- and three-dimensional ICUS respectively. The kappa values for correlation of dissection type were 0.29 (0.23-0.35) and 0.64 (0.57-0.71) respectively indicating better agreement using combined two- and three-dimensional ICUS. Two-dimensional ICUS consistently underestimated dissection length (3.52+/-1.75 mm compared with 6.54+/-2.42 mm, P<0.001) and depth (0.61+/-0.24 mm compared with 0.92+/-0.32 mm, P=0.001). Combined two- and three-dimensional ICUS produced accurate dissection length (6.13+/-2.29 mm compared with 6.54+/-2.42 mm, P=0.09) and depth (0.86+/-0.32 mm compared with 0.92+/-0.32 mm, P=0.28) estimations.


CONCLUSIONS
Computerized three-dimensional reconstruction of ICUS images provides improved accuracy compared to conventional ICUS imaging in the detection and quantitation of arterial dissection. This technique would be a useful adjunct to angiography for the precise assessment of vascular injury following PTCA.
Palmer
Nicholas D
ND
Departments of Cardiology and Pathology, Western General Hospital, Royal Infirmary of Edinburgh, Edinburgh, Scotland, UK. nickpalmer@blueyonder.co.uk
Lessells
Alistair
A
Northridge
David B
DB
Fox
Keith A A
KA
D000784:Aortic Dissection / Q000175:diagnosis / Q000209:etiology / Q000473:pathology; D015906:Angioplasty, Balloon, Coronary; D001158:Arteries / Q000000981:diagnostic imaging / Q000473:pathology; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D003331:Coronary Vessels / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D021621:Imaging, Three-Dimensional; D011183:Postoperative Complications / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology; D012720:Severity of Illness Index; D013223:Statistics as Topic; D016896:Treatment Outcome; D018084:Ultrasonography, Interventional; D014652:Vascular Diseases / Q000175:diagnosis* / Q000209:etiology* / Q000473:pathology