BACKGROUND AND OBJECTIVES: A reduction of the coronary flow reserve (CFR) following successful percutaneous coronary intervention (PCI) is related to microvascular impairment. Embolization of atherosclerotic debris during PCI is a possible explanation for the finding of abnormal coronary Doppler flow following PCI. SUBJECTS AND METHODS: The CFR and intravascular ultrasound (IVUS), both before and after PCI, were recorded in 69 lesions of 69 patients with coronary artery disease. An abnormal CFR was defined as one with no change or a decrease after successful PCI. RESULTS: The patients were divided into abnormal (n=17) and normal CFR (n=52) groups. After stenting, the hyperemic flow velocity was significantly lower in the abnormal CFR group (39.3+/-12.6 vs. 48.9+/-15.4 cm/s, p=0.022). 94 and 29% of the abnormal group had soft plaques and lipid cores, respectively, compared with 62 and 2% in the normal CFR group (soft plaque: p=0.029, lipid core: p=0.002). The abnormal CFR group had smaller post-procedural vessels (15.1+/-4.2 vs. 18.2+/-4.9 mm2, p=0.039) and plaque areas (6.8+/-2.7 vs. 9.9+/-3.8 mm2, p=0.006). Furthermore, the abnormal CFR group showed less vessel expansion (1.7+/-5.5 vs. 5.0+/-3.9 mm2, p=0.018) and greater plaque loss (4.1+/-5.3 vs. 0.7+/-3.4 mm2, p=0.009). The abnormal CFR group had an increased CK-MB following PCI (4 patients, 23.5% vs. 2 patients, 3.8%, p=0.029). In a multivariable analysis, the only predictor of an abnormal CFR was the presence of a lipid core within the plaque. CONCLUSION: Soft plaques, the presence of a lipid core and a large reduction in plaques increase the risk of microembolization during the PCI procedure.
Coronary Artery Disease ; Humans ; Percutaneous Coronary Intervention ; Stents* ; Ultrasonics ; Ultrasonography*

Intravascular ultrasound is a usful too to assess the adequate stent strut expansion after stent implantation and nowadays it can bo also used as a dicision making method about omitting anticoagulant therapy. We used intravascular ultrasound before and after Palmz-schatz stent implantation in 3 patients with coronary artery narrowings and analysed serial post porcedure lumen diameter, cross sectional area. We think it is a useful tool to assess the effect of stent implantation and post stent balloon dilatation.
Coronary Artery Disease ; Coronary Vessels ; Dilatation ; Humans ; Methods ; Stents ; Ultrasonography

BACKGROUND AND OBJECTIVES: Intracoronary stenting now constitute the majority of coronary interventions, and subsequently in-stent restenosis has become a significant clinical problem. Recently, several studies on intracoronary radiation therapy, in patients with in-stent restenosis, have demonstrated a reduction in binary angiographic restenosis and target lesion revascularization compared with control groups. The effects of beta-radiation therapy on non-stented adjacent segments in in-stent restenosis have not been sufficiently evaluated. beta-radiation therapy for in-stent restenosis was performed with a 188Re-MAG3 filled balloon. SUBJECTS AND METHODS: We evaluated, and compared, the effects of beta-radiation therapy on non-stented adjacent segments, in in-stent restenosis, by intravascular ultrasound (IVUS) analysis, between 50 patients who received radiation therapy and 9 controls. The changes (delta: follow-up-post-intervention) of the external elastic membrane (EEM), the lumen and other IVUS variables, were compared between the segments having received radiation therapy and those in the controls. RESULTS: Significant differences were found between the 2 groups, and were as follows: the delta EEM and delta lumen areas were 0.3mm2 and -1.0mm2, (p=0.005) and 0.2mm2 and -1.3mm2, (p<0.001) in those radiated and the controls, respectively. CONCLUSION: In conclusion, compared with the changes on the vessel shrinkage of the control group, there was significant vessel enlargement in the non-stented adjacent segments having received radiation therapy.
Brachytherapy ; Coronary Artery Disease ; Humans ; Membranes ; Stents ; Ultrasonography* ; Ultrasonography, Interventional

BACKGROUND AND OBJECTIVES: Intravascular ultrasound (IVUS), following stent implantation, demonstrated a significant degree of underexpansion, despite the initial appearance of an angiographically successful deployment, in first-generation stents. With improvements in stent designs and delivery systems, the current-generation of stents appear to achieve optimal stent expansion. The purpose of this study was to evaluate optimal stent expansion, by nominal pressure balloon inflation, in the current generation of stents. SUBJECTS AND METHODS: We evaluated 30 patients having had Nir-Sox, Tristar, S670 or Bx Velocity stents successfully deployed at nominal pressure (7-10 atm) with delivery balloon system, between March and September 2001, using IVUS. IVUS criterion for optimal stent expansion was defined as a minimal stent area (MSA) ratio of > OR =0.8 of the average reference lumen area. RESULTS: The mean nominal balloon pressure was 8.87+/-0.9 atmospheres and the mean stent size was 3.38+/-0.45 mm. In reference segments, the minimal lumen diameter and average lumen area, found from the IVUS, were 3.18+/-0.51 mm and 8.88+/-2.92 mm 2 , respectively. In stented segments, the minimal stent diameter and MSA were 2.55+/-0.46 mm and 6.10+/-2.08 mm 2 , respectively. In only 11 of the 30 patients (36.7%) was the optimal stent expansion, by IVUS, achieved. CONCLUSION: Despite the development of a balloon delivery system for the current generation of stents, 63.3% of our study patients did not achieve optimal stent expansion, by IVUS, following nominal balloon inflation. Therefore, additional procedure will be required for optimal stent expansion in the current generation of stents.
Atmosphere ; Coronary Disease ; Humans ; Inflation, Economic* ; Stents* ; Ultrasonography* ; Ultrasonography, Interventional

BACKGROUND: Intravascular ultrasound(IVUS) provides high resolution cross-sectional images of the vessels and permits the quantiative and qualitative assessment of coronary artery disease. Stent is a figid endovascular lattice that effectively prevents elastic recoil at treated sites, but in-stent restenois is a major limitation. The purpose of thecurrent study is to assess the contribution of neointimal hyperplasia for in-stent restenosis and the distribution and morphological characteristics of neointimal hyperplasia in deployed stents. METHODS: Thirty patients(male 25 & female 5;31 leions) deployed with intracoronary stents underwent intravascular ultrasound imaging at follow-up at least 4 months after stenting ([mean+/-SD] 8.3+/-2.9 months). RESULTS: 1) In-stent restenosis occurered in 15 lesions out of 31 lesions at follow-up coronary angiography. There was no difference in clinical characteristics between the restenotic and the non-restenotic groups. 2) There was no difference in angiographic profiles between two groups. Deployed stents were as follows ; 16 Palmaz-Schatz(P-S) stents, 12 Gianturco-Roubin(G-R) stents, 2 Cordis stents, and I Microstent II. Average diameter of stents in the restenotic and the non-restenotic groups were 3.07+/-0.26mm and 3.16+/-0.30mm, respectively(p=0.38). 3) There was no difference of stent cross-sectional areas(CSA) between the non-restenotic and the restenotic groups(p=0.476), but luminal CSA of the restenotic group was significantly smaller than that of the non-restenotic group(p=0.006). 4) In the restenotic group, there were no differences of the maximal and the minimal diameters of stents, and the mean CSAs of stents smong proxiaml, mid and distal segments. But the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.05). There was a tendency thatthe mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.187). These findings were the same in the non-restenotic group. 5) In the restenotic group deployed with P-S stents, there were no differences of the maximal and the minimal diameters of stents, and the mean cross-sectional areas(CSA) of stents between each segment. But, the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the distal segment(p<0.005) and there was a tendency that the mean CSA of neointimal hyperplasia at the mid segment was larger than that at the proximal segment(p=0.354). 6) In the morphology of neointimal hyperplasia of the restenotic group, eccentric form(77%) was more common than concentric form(22%). Neointimal hyperplasia occurred in focal or diffuse patterns(7 versus 8 cases). CONCLUSIONS: In-stent restenosis resulted from neointimal hyperplasia which almost mainly occurred eccentrically at the mid segment of stents and in focal or diffuse patterns. Intravascular ultrasound imaging was a useful method for recognition of distribution and morphological characteristics of neointimal hyperplasia at follow-up of deployed stents.
Coronary Angiography ; Coronary Artery Disease ; Coronary Vessels* ; Female ; Follow-Up Studies ; Humans ; Hyperplasia* ; Phenobarbital ; Stents* ; Ultrasonography*

BACKGROUND: Carotid intima-media thickness (IMT) or the presence of carotid plaque has been reported to be related to coronary artery disease (CAD). We evaluated the relationship of the parameters of carotid ultrasonography (US) with the severity of the CAD. METHODS: From November, 2005 to November, 2006, the patients who underwent both coronary angiography and carotid US were enrolled in our study. The severity of CAD was defined by the number of diseased major coronary arteries with a percent diameter stenosis over 50. Four groups including Group 0, which has normal coronary arteries, were compared. The average and maximal IMT and the presence of plaque were used as the parameters of carotid US. RESULTS: The total number of patients was 90. Men had a greater severity of CAD (p=0.001). The average carotid IMTs were increased with the severity of CAD (Group 0, 0.67+/-0.11 mm; Group 1, 0.66+/-0.13 mm; Group 2, 0.68+/-0.08 mm; Group 3, 0.78+/-0.10 mm; p=0.001). The maximal carotid IMTs were also increased (Group 0, 0.88+/-0.16 mm; Group 1, 0.85+/-0.20 mm; Group 2, 0.89+/-0.13 mm; Group 3, 1.06+/-0.17 mm; p=0.000). Carotid plaques were also more frequently present with the increased severity of CAD (p=0.004). CONCLUSIONS: Increased carotid IMT and the presence of carotid plaque were related to the severity of CAD. Carotid ultrasonography is useful for evaluating the severity of CAD.
Carotid Intima-Media Thickness ; Constriction, Pathologic ; Coronary Angiography ; Coronary Artery Disease* ; Coronary Vessels* ; Humans ; Male ; Ultrasonography*

BACKGROUND: It is not clear how much amount is favourable to coronary heart disease, although cardioprotective effects of red wine were reported. Furthermore, there is no report showing the effects of soju, the popular liqour in Korea on endothelial function. We performed this study to know early effects of alcohol on endothelial function in healthy subjects according to the kinds and the amounts of alcohol. METHODS: Endothelial function was measured by using high-resolution ultrasound in 20 healthy subjects. Ten subjects were crossover studied according to the types of alcohol (120 cc of red wine and 45 cc of soju) and the other ten subjects were studied using the half dosage of the same alcohol. RESULTS: The endothelial function can be impaired during 1 to 2 hours after alcohol ingestion (Soju 45 cc and red wine 120 cc, p<0.05), then recovered to baseline level. However, these impaired endothelial functions were associated with an increased brachial artery diameter. The endothelial function was recovered to baseline level more earlier in case of red wine than that of soju 2 hours vs 3 hours. Red wine 60cc and Soju 22.5 cc can improve the endothelial function in healthy subjects 2 and 3 hours after ingestion, respectively. These effects were not related with vasodilatory effects of alcohol. CONCLUSION: This study suggests that small amounts of alcohol can improve the endothelial function in healthy subjects independently with the vasodilatory effects of alcohol.The amounts of alcohol showing beneficial effects on endothelial function were lower than our expectation (a half cup).
Brachial Artery ; Coronary Disease ; Eating ; Korea ; Ultrasonography ; Wine

Chronic Disease ; Coronary Occlusion/surgery* ; Humans ; Treatment Outcome ; Ultrasonography, Interventional

Coronary Artery Disease ; Humans ; Tomography, Optical Coherence ; Ultrasonography, Interventional

PURPOSE: Accurate evaluation of side branch (SB) ostium could be critical to the treatment of bifurcation lesions. We compared measured and calculated values of side branch ostial length (SBOL) in coronary bifurcation lesions with intravascular ultrasound (IVUS). MATERIALS AND METHODS: Pre-intervention and post-intervention IVUS was performed in 113 patients who underwent stent implantation of bifurcation lesions. For the IVUS longitudinal reconstruction of the bifurcation lesions, SBOL, SB diameter, and the angle between the distal portion of the main vessel (MV) and SB were directly measured. In addition, SBOL was calculated as: SB diameter/sin (angle between distal MV and SB). The relationship between measured and calculated SBOL was then evaluated. RESULTS: The angled between the distal MV and SB were 57.3+/-12.4degrees at pre-intervention and 59.4+/-12.6degrees at post-intervention. The mean measured and calculated SBOL values were 2.91+/-0.86 mm and 3.06+/-0.77 mm at pre-intervention and 2.79+/-0.82 mm and 2.92+/-0.69 mm at post-intervention, respectively. Differences between measured and calculated SBOL were 0.15+/-0.44 mm at pre-intervention and 0.13+/-0.41 mm at post-intervention. We found that calculated SBOL was correlated with measured SBOL (pre-intervention r=0.863, p<0.001; post-intervention r=0.868, p<0.001). CONCLUSION: There was a good correlation between measured and calculated SBOLs of the bifurcation lesions in IVUS longitudinal reconstruction. SBOL in the bifurcation lesions can therefore be estimated using the SB diameter and the angle between distal MV and SB.
Aged ; Angioplasty, Balloon, Coronary ; Coronary Angiography ; Coronary Artery Disease/surgery/*ultrasonography ; Coronary Vessels/*ultrasonography ; Female ; Humans ; Male ; Middle Aged ; Ultrasonography, Interventional