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Intravasaler Ultraschall — Einsatz zur Plaquedetektion und Therapieentscheidung

  • Günter Görge

Zusammenfassung

Der intravasale Ultraschall (IVUS) hat einen festen Platz in der invasiven kardiovaskulären Diagnostik erobert. Durch die intraluminale Positionierung von miniaturisierten Echosonden mit einem Durchmesser von 2,9–10 French können tomographische Abbildungen des Gefäßlumens und der Gefaßwand erzeugt werden. Der IVUS ist derzeit die einzige Methode, die eine Beurteilung der Plaque-morphologie in vivo zuläßt. Darüber hinaus kann der IVUS angiographisch oft schwer abzuschätzende Veränderungen am Hauptstamm verifizieren und das Ausmaß arteriosklerotischer Veränderung bei angiographisch „normalen“ Kranzarterien darstellen. Der IVUS hilft bei der Therapieoptimierung, da er in vivo die Effekte der PTCA auf die Plaque- und Gefaßwandmorphologie darstellen und die residuale Flächenstenose nach PTCA bestimmen kann. Der IVUS konnte zeigen, daß ein wesentlicher Effekt der PTCA in der Dehnung des Gesamtgefäßes besteht. Selbst nach angiographisch erfolgreicher PTCA liegt die mittels IVUS bestimmte Restflächenstenose im Mittel bei 55–60%. Der mittels IVUS bestimmte residuale minimale Gefäßdurchmesser nach PTCA und die residuale Plaquefläche sind prognostisch wichtige Indikatoren für die Entwicklung einer Restenose nach PTCA, deren Hauptmechanismus nicht die Intimahyperplasie, sondern die chronische Gefäßschrumpfung ist. Die IVUS-optimierte PTCA führt durch die Verwendung größerer Ballons zu einem größeren postinterventionellen Lumen ohne erhöhte Komplikationsrate. Durch die IVUS-gesteuerte Hochdruckimplantation von koronaren Stents konnte eine Vergrößerung des postinterventionellen minimalen Lumendiameters erreicht und die Rate der subakuten Stent-thrombosen gesenkt werden. Für die Zukunft des intravasalen Ultraschalls wesentlich ist die noch bessere Integration des IVUS in den Untersuchungsablauf im Katheterlabor.

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Copyright information

© Dr. Dietrich Steinkopff Verlag, Darmstadt 2000

Authors and Affiliations

  • Günter Görge
    • 1
  1. 1.Medizinische Klinik IIStädtische Saarbrücker WinterbergklinikenSaarbrückenDeutschland

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