血管內(nèi)超聲基礎(chǔ)和臨床應(yīng)用進(jìn)展IVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和臨床應(yīng)用進(jìn)展IVUS培訓(xùn)IVUS培訓(xùn)IVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)二、血管內(nèi)超聲和冠脈造影的關(guān)系三、主要適應(yīng)癥四、什么是VHIVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)IVUS培訓(xùn)RotatingElementDriveShaftMulti-elementArrayTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkTherearetwotypesofimagingsystems:Mechanical(rotatingtransducer)andElectronicArrayIVUS培訓(xùn)RotatingElementDriveShaftMulHighfrequencysoundwavesechooffvesselwallsandaresentbacktosystemSystemelectronicsprocessthesignalTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)HighfrequencysoundwavesechALA=AxialResolutionL=LateralResolutionTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)ALA=AxialResolutionTheCardLowdynamicrangeHighdynamicrangeTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)LowdynamicrangeHighdynamicIntimaldisease(plaque)isdenseandwillappear‘white’Mediaismadeofhomogeneoussmoothmusclecellsanddoesnotreflectultrasound(appearsdark)Adventitiahas‘sheets’ofcollagenthatreflectalotofultrasound(appearswhite)TheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)Intimaldisease(plaque)isdeTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)TheCardiovascular

ResearchFoCalciumBrightechoes(brighterthantheadventitia)Obstructsthepenetrationofultrasound(acousticshadowing)onlytheleadingedgeisdetectedandthicknesscannotbedetermined.Resultsinreverberations-theoscillationofultrasoundbetweentransducerandcalciumcausingrepeating‘a(chǎn)rcs’IVUS培訓(xùn)CalciumBrightechoes(brighter80°SuperficialDeepDeepCalciumisquantifiedbymeasuringthe“arc”itencompassesCalciumisclassifiedbyitslocationwithintheplaqueSuperficialcalciumisclosertothelumenthantotheadventitiaDeepcalciumisclosertotheadventitiathantothelumenTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)80°SuperficialDeepDeepCalciumFibroticPlaqueAsbrightorbrighterthantheadventitia(hyperechoic)MajorityofatheroscleroticlesionsarefibroticVerydense,fibrousplaquesmaycausesomuchacousticshadowingthattheycouldbemisclassifiedascalcifiedIVUS培訓(xùn)FibroticPlaqueAsbrightorbrSoftPlaqueNotasbrightastheadventitia(hypoechoic)“Soft”referstothelowechogenicity,generallyduetohighlipidcontentinamostlycellularlesion.Reducedechodensitymayalsobedueto:necroticzonewithinplaqueintramuralhemorrhagethrombusIVUS培訓(xùn)SoftPlaqueNotasbrightasthVulnerablePlaqueFibrousCapLipidCoreIVUS培訓(xùn)VulnerablePlaqueFibrousCapLiMixedPlaqueIVUS培訓(xùn)MixedPlaqueIVUS培訓(xùn)014mmExampleofThrombusIVUS培訓(xùn)014mmExampleofThrombusIVUS培ExamplesofThrombusIVUS培訓(xùn)ExamplesofThrombusIVUS培訓(xùn)BasicMeasurements(I)Externalelasticmembrane(EEM)crosssectionalarea(CSA)=totalarterialCSA=‘media’areatracingtheboundarybetweenthedarkmediaandthe

brightadventitia(i.e.,theapparentouteredgeofthemediastripe)LumenCSAMaxandminlumendiametersStentCSAMaxandminstentdiametersPlaque+media(P+M)CSA=EEM-LumenCSAinnon-stentedlesions=EEM-stentCSAinstentedlesionsIntimalhyperplasiaCSA=Stent-LumenCSAIVUS培訓(xùn)BasicMeasurements(I)ExternalBasicMeasurements(II)Eccentricity=maximum/minimumP+MthicknessPlaqueBurden(=cross-sectionalnarrowingor%plaquearea)=P+M/EEMCSARemodelingIndex=Lesion/ReferenceEEMCSAAreaStenosis=(Reference-Lesion)/ReferenceLumenCSAArcofcalciumLesionlengthsmeasuredusingmotorizedtransducerpullback,ideallyat0.5mm/secIVUS培訓(xùn)BasicMeasurements(II)EccentrNon-stentedarteryEEMGuidewiresIVUScatheterPlaque+mediaLumenIVUS培訓(xùn)Non-stentedarteryEEMGuidewireStentedArteryEEMLumenStentGuidewireIVUScatheterPlaque+mediaIntimalhyperplasiaIVUS培訓(xùn)StentedArteryEEMLumenStentGuiProximalReferenceLesionSiteDistalReferenceEEMLumenP+MMaxP+MThicknessMinP+MThicknessCa++TheCardiovascular

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InstituteofNewYorkIVUS培訓(xùn)ProximalReferenceLesionDistal03mm12mmProximalReferenceLesionSiteDistalReferenceEEMCSA=20.4LumenCSA=9.7Maxlumendiam=3.7MLD=3.1P+MCSA=10.7Eccentricity=1.0/0.3Plaqueburden=0.52ArcofCa=60EEMCSA=21.6LumenCSA=4.5Maxlumendiam=32.8MLD=2.3P+MCSA=17.1Eccentricity=3.0/0.1Plaqueburden=0.79EEMCSA=13.3LumenCSA=8.9Maxlumendiam=3.6MLD=3.0P+MCSA=4.4Eccentricity=0.6/0.2Plaqueburden=0.33AverageReferenceEEMCSA=16.9RemodelingIndex=1.3AverageReferenceLumenCSA=9.3AreaStenosis=52%TheCardiovascular

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InstituteofNewYorkIVUS培訓(xùn)03mm12mmProximalReferenceLesiIn-StentRestenosisIn-stentintimalhyperplasia(IH)oftenappearswithaverylowechogenicityCouldbelessechogenicthanthebloodspeckleAppropriatesystemsettingsarecriticaltovisualizeIH(donot“blackout”center)IVUS培訓(xùn)In-StentRestenosisIn-stentin血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)二、血管內(nèi)超聲和冠脈造影的關(guān)系三、主要適應(yīng)癥四、什么是VHIVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)IVUS培訓(xùn)LimitationsofCoronaryAngiographyFocalDisease50%Lesion50%LesionDiffuseDiseaseAngiogramSilhouetteIVUS培訓(xùn)LimitationsofCoronaryAngiogAngiographicallySilentDiseaseIn884nativecoronaryarteries,theplaqueburdenintheangiographically“normal”referencesegmentwas51±13%MintzGS,etal.JAmCollCardiol1995;25:1479-1485IVUS培訓(xùn)AngiographicallySilentDiseasCoronaryRemodelingHypothesisCompenatoryExpansion

MaintainsConsistantLumenExpansion

Overcome:LumenNarrowsNormalVesselMinimalCADModerateCADSevereCADIVUS培訓(xùn)CoronaryRemodelingHypothesisProximalreferenceLesionDistalreferenceIntermediateremodelingNegativeremodelingPositiveremodelingNishioka.

JACC1996;27:1571-1576DicotomousClassificationofRemodelingIVUS培訓(xùn)ProximalreferenceLesionDistalABDEff'CFdistalLumenebe'b'LumenPositiveRemodelingNegativeRemodelingcc'distalEEMEEMIVUS培訓(xùn)ABDEff'CFdistalLumenebe'b'LumeLimitationsofCoronaryAngiographyAngiogramSilhouetteCoronaryCross-section75%25%IVUS培訓(xùn)LimitationsofCoronaryAngiogIrregularPlaque/IrregularLumenACross-sectionRAOViewLAOViewBCIVUS培訓(xùn)IrregularPlaque/IrregularLTheCardiovascular

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InstituteofNewYorkIVUSEEMCSA=22.7mm2LumenCSA=16.6mm2Meanlumendiameter=4.6mmQCA9FguidingcatheterReferencediameter=3.12mmIVUS培訓(xùn)TheCardiovascular

ResearchFo血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)二、血管內(nèi)超聲和冠脈造影的關(guān)系三、主要適應(yīng)癥四、什么是VHIVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)IVUS培訓(xùn)IVUS培訓(xùn)(Fisheretal.CCD1982;8:565-575)Comparisonbetweenpercentstenosisassessmentfromthequalitycontrollabvstheclinicalsite*areaofthesquareisproportionaltothenumberofcaseswiththegivenreadingQClabClinicalsite10001000Ofallthecoronarysegments,theLMistheonewiththegreatestinter-observervariability

PoorinterobserveragreementintheangiographicassessmentofLMCAstenosisintheCASSstudy-IIVUS培訓(xùn)PoorinterobserveragreementintheangiographicassessmentofLMCAstenosisintheCASSstudy-II(Cameronetal.Circulation1983;68:484-489)FivegradesofLMseverity1: 0-24%DS2: 25-49%DS3: 50-74%DS4: 75-89%DS5: 90-100%DS#ofgradesofdifferenceinassessmentofLMseverity0: nodifference+1or-1: 1gradedifference+2or-2: 2gradesofdifference+3or-3: 3gradesofdifference+4or-4: 4gradesofdifferenceClinicalsitevs

QualitycontrolClinicalsitevs

StudyGroupStudyGroupvsQualitycontrolIVUS培訓(xùn)PoorinterobserveragreementiIVUS培訓(xùn)ReferenceLesion10mmLumenCSA=18.3mm2Lumendiameter=5.0mmLumenCSA=3.6mm2Lumendiameter=1.3mmLumenCSA=11.9mm2Lumendiameter=3.5mmPatientwithnormalostialLMCAwhopreviouslyunderwentCABGforpresumedLMCAdiseasePatientwithsevere,butunrecognized,distalLMCAstenosiswhowasreferredforPTCAofLADIVUS培訓(xùn)SuggestedIVUSCriteriafora‘Significant’LMCAStenosisMostIVUSLMCAstudiesshoweitherinsignificantdiseaseorcriticaldisease,onlyaminorityrequirecarefulquantificationLumenCSA<6.0mm2orMLD<3.0mmaresuggestedcriteriaforasignificantLMCAstenosisThesumofthelumenareasofthetwodaughtervessels(LADandLCX,eachofwhichshouldbe4.0mm2)=150%oftheparent(LM)ThesecorrelatedwithanabnormalFFR(JastietalCirculation2004;110:2831-6)IVUS培訓(xùn)SuggestedIVUSCriteriaforaIVUS培訓(xùn)UnusualLesions:IVUSClassificationofAngiographicAneurysmsOf77angiographicaneurysms21(27%)trueaneurysm3(4%)pseudoaneurysm12(16%)complexplaquesorunhealeddissections41(53%)normalsegmentadjacenttooneormorestenosesTrue

AneurysmPSAComplex

PlaqueNormalSitewith

AdjacentStenosesNopriorPCI100626PriorPCI113615(Maeharaetal.AmJCardiol2001;88:365-70)IVUS培訓(xùn)018mmNormalSegmentwithAdjacentStenoses018mmNormalSegmentwithAdjacTrueAneurysmTrueAneurysm2mm010mmPseudoaneurysm2mm010mmPseudoaneurysmRupturedPlaqueRupturedPlaqueProximalDistalLesion5.5mm

MaxLD=3.5mm

MaxLD=3.3mm6mmStentsizingusingIVUSReferencesegmentdiseaseprovidesacushionforoversizingProximalDistalLesion5.5mmMaxThehighpredictivevalue(90%)fortheminimumstentCSAinCypherstentssuggeststhatmostcausesofCypherstentfailurewillbe“mechanical”

01020304050607080901003.54.06.57.07.58.08.5F/UMLA>4.0mm2(%)Cypher5.0**sensitivityspecificity01020304050607080901003.54.04.55.05.56.07.07.58.08.5F/UMLA>4.0mm2(%)BareMetalStents6.5*Minimumstentarea(mm2)Minimumstentarea(mm2)(Sonodaetal.JAmCollCardiol2004;43:1959-63)*predictivevalue=56%**predictivevalue=90%Thehighpredictivevalue(90%Predictorsofangiographicrestenosisin550ptswith670nativearterylesionstreatedwithCypherstents0204060801000204060801003.54.04.55.05.56.06.57.07.5Angiographicrestenosis(%)Angiographicrestenosis(%)IVUSMSA(mm2)10152025303540455560657075IVUStotalstentlength(mm)<5.5mm2≥5.5mm2≤40mm2.4%0.4%>40mm17.7%8.6%(Hongetal.unpublished)PredictorsofangiographicresComparisonofIVUS-measuredminimumstentdiameter(MSD)andminimumstentarea(MSA)withthepredictedmeasurementsfromCordis(Cypherinyellow,n=133)andBSC(Taxusinred,n=67).DESachieveanaverageofonly75%ofthepredictedMSD(66%ofMSA)IVUSMeasuredMSA(mm2)PredictedMSA(mm2)IVUSMeasuredMSD(mm)PredictedMSD(mm)24%ComparisonofIVUS-measuredmiPeri-StentHaziness:DoubleLumenPeri-StentHaziness:DoubleLuPeri-StentHaziness:PlaqueBurdenTwoOverlappingStentsHazySegmentPeri-StentHaziness:PlaqueBPeri-StentHaziness:CalcificationStentPeri-StentHaziness:CalcificPeri-StentInjury:PlaqueTearUltrasoundSiteStentPeri-StentInjury:PlaqueTear何時(shí)采用IVUS以達(dá)到最佳的DES置入高?；颊邅喗M腎功能不全SAT雙重抗血小板藥物使用的局限性SAT糖尿病ISR,SAT左心室功能差SAT高危病變亞組分叉病變ISR,SAT開口病變ISR小血管ISR長(zhǎng)病變ISR治療支架內(nèi)再狹窄（ISR）ISR左主干病變

(特別是具有上述矛盾的結(jié)果和危險(xiǎn)因素)何時(shí)采用IVUS以達(dá)到最佳的DES置入高?；颊邅喗M血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)二、血管內(nèi)超聲和冠脈造影的關(guān)系三、主要適應(yīng)癥四、什么是VHIVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)IVUS培訓(xùn)IVUSPCwith500MHzandreconstructionsoftwareEliminatetheS-VHSVCRVirtualHistologyTMVolcanoIVUS培訓(xùn)IVUSPCwith500MHzEliminateVirtualHistologyTMVolcanoFIBROTICFIBRO-LIPIDCALCIFICLIPID

COREMEDIALegendClassificationIVUS培訓(xùn)VirtualHistologyTMVolcanoFIBComparisonBetweenVHandHistologyDiagnosticaccuracyNairetal.Circulation2002IVUS培訓(xùn)ComparisonBetweenVHandHistFIBROTICFIBRO-LIPIDICLIPIDIC-CORECALCIFICVirtualHistologyTMEx-VivoValidationIVUS培訓(xùn)FIBROTICFIBRO-LIPIDICL謝謝！IVUS培訓(xùn)IVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和臨床應(yīng)用進(jìn)展IVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和臨床應(yīng)用進(jìn)展IVUS培訓(xùn)IVUS培訓(xùn)IVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)二、血管內(nèi)超聲和冠脈造影的關(guān)系三、主要適應(yīng)癥四、什么是VHIVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)IVUS培訓(xùn)RotatingElementDriveShaftMulti-elementArrayTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkTherearetwotypesofimagingsystems:Mechanical(rotatingtransducer)andElectronicArrayIVUS培訓(xùn)RotatingElementDriveShaftMulHighfrequencysoundwavesechooffvesselwallsandaresentbacktosystemSystemelectronicsprocessthesignalTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)HighfrequencysoundwavesechALA=AxialResolutionL=LateralResolutionTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)ALA=AxialResolutionTheCardLowdynamicrangeHighdynamicrangeTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)LowdynamicrangeHighdynamicIntimaldisease(plaque)isdenseandwillappear‘white’Mediaismadeofhomogeneoussmoothmusclecellsanddoesnotreflectultrasound(appearsdark)Adventitiahas‘sheets’ofcollagenthatreflectalotofultrasound(appearswhite)TheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)Intimaldisease(plaque)isdeTheCardiovascular

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InstituteofNewYorkIVUS培訓(xùn)TheCardiovascular

ResearchFoCalciumBrightechoes(brighterthantheadventitia)Obstructsthepenetrationofultrasound(acousticshadowing)onlytheleadingedgeisdetectedandthicknesscannotbedetermined.Resultsinreverberations-theoscillationofultrasoundbetweentransducerandcalciumcausingrepeating‘a(chǎn)rcs’IVUS培訓(xùn)CalciumBrightechoes(brighter80°SuperficialDeepDeepCalciumisquantifiedbymeasuringthe“arc”itencompassesCalciumisclassifiedbyitslocationwithintheplaqueSuperficialcalciumisclosertothelumenthantotheadventitiaDeepcalciumisclosertotheadventitiathantothelumenTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)80°SuperficialDeepDeepCalciumFibroticPlaqueAsbrightorbrighterthantheadventitia(hyperechoic)MajorityofatheroscleroticlesionsarefibroticVerydense,fibrousplaquesmaycausesomuchacousticshadowingthattheycouldbemisclassifiedascalcifiedIVUS培訓(xùn)FibroticPlaqueAsbrightorbrSoftPlaqueNotasbrightastheadventitia(hypoechoic)“Soft”referstothelowechogenicity,generallyduetohighlipidcontentinamostlycellularlesion.Reducedechodensitymayalsobedueto:necroticzonewithinplaqueintramuralhemorrhagethrombusIVUS培訓(xùn)SoftPlaqueNotasbrightasthVulnerablePlaqueFibrousCapLipidCoreIVUS培訓(xùn)VulnerablePlaqueFibrousCapLiMixedPlaqueIVUS培訓(xùn)MixedPlaqueIVUS培訓(xùn)014mmExampleofThrombusIVUS培訓(xùn)014mmExampleofThrombusIVUS培ExamplesofThrombusIVUS培訓(xùn)ExamplesofThrombusIVUS培訓(xùn)BasicMeasurements(I)Externalelasticmembrane(EEM)crosssectionalarea(CSA)=totalarterialCSA=‘media’areatracingtheboundarybetweenthedarkmediaandthe

brightadventitia(i.e.,theapparentouteredgeofthemediastripe)LumenCSAMaxandminlumendiametersStentCSAMaxandminstentdiametersPlaque+media(P+M)CSA=EEM-LumenCSAinnon-stentedlesions=EEM-stentCSAinstentedlesionsIntimalhyperplasiaCSA=Stent-LumenCSAIVUS培訓(xùn)BasicMeasurements(I)ExternalBasicMeasurements(II)Eccentricity=maximum/minimumP+MthicknessPlaqueBurden(=cross-sectionalnarrowingor%plaquearea)=P+M/EEMCSARemodelingIndex=Lesion/ReferenceEEMCSAAreaStenosis=(Reference-Lesion)/ReferenceLumenCSAArcofcalciumLesionlengthsmeasuredusingmotorizedtransducerpullback,ideallyat0.5mm/secIVUS培訓(xùn)BasicMeasurements(II)EccentrNon-stentedarteryEEMGuidewiresIVUScatheterPlaque+mediaLumenIVUS培訓(xùn)Non-stentedarteryEEMGuidewireStentedArteryEEMLumenStentGuidewireIVUScatheterPlaque+mediaIntimalhyperplasiaIVUS培訓(xùn)StentedArteryEEMLumenStentGuiProximalReferenceLesionSiteDistalReferenceEEMLumenP+MMaxP+MThicknessMinP+MThicknessCa++TheCardiovascular

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InstituteofNewYorkIVUS培訓(xùn)ProximalReferenceLesionDistal03mm12mmProximalReferenceLesionSiteDistalReferenceEEMCSA=20.4LumenCSA=9.7Maxlumendiam=3.7MLD=3.1P+MCSA=10.7Eccentricity=1.0/0.3Plaqueburden=0.52ArcofCa=60EEMCSA=21.6LumenCSA=4.5Maxlumendiam=32.8MLD=2.3P+MCSA=17.1Eccentricity=3.0/0.1Plaqueburden=0.79EEMCSA=13.3LumenCSA=8.9Maxlumendiam=3.6MLD=3.0P+MCSA=4.4Eccentricity=0.6/0.2Plaqueburden=0.33AverageReferenceEEMCSA=16.9RemodelingIndex=1.3AverageReferenceLumenCSA=9.3AreaStenosis=52%TheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUS培訓(xùn)03mm12mmProximalReferenceLesiIn-StentRestenosisIn-stentintimalhyperplasia(IH)oftenappearswithaverylowechogenicityCouldbelessechogenicthanthebloodspeckleAppropriatesystemsettingsarecriticaltovisualizeIH(donot“blackout”center)IVUS培訓(xùn)In-StentRestenosisIn-stentin血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)二、血管內(nèi)超聲和冠脈造影的關(guān)系三、主要適應(yīng)癥四、什么是VHIVUS培訓(xùn)血管內(nèi)超聲基礎(chǔ)和進(jìn)展一、血管內(nèi)超聲基礎(chǔ)IVUS培訓(xùn)LimitationsofCoronaryAngiographyFocalDisease50%Lesion50%LesionDiffuseDiseaseAngiogramSilhouetteIVUS培訓(xùn)LimitationsofCoronaryAngiogAngiographicallySilentDiseaseIn884nativecoronaryarteries,theplaqueburdenintheangiographically“normal”referencesegmentwas51±13%MintzGS,etal.JAmCollCardiol1995;25:1479-1485IVUS培訓(xùn)AngiographicallySilentDiseasCoronaryRemodelingHypothesisCompenatoryExpansion

MaintainsConsistantLumenExpansion

Overcome:LumenNarrowsNormalVesselMinimalCADModerateCADSevereCADIVUS培訓(xùn)CoronaryRemodelingHypothesisProximalreferenceLesionDistalreferenceIntermediateremodelingNegativeremodelingPositiveremodelingNishioka.

JACC1996;27:1571-1576DicotomousClassificationofRemodelingIVUS培訓(xùn)ProximalreferenceLesionDistalABDEff'CFdistalLumenebe'b'LumenPositiveRemodelingNegativeRemodelingcc'distalEEMEEMIVUS培訓(xùn)ABDEff'CFdistalLumenebe'b'LumeLimitationsofCoronaryAngiographyAngiogramSilhouetteCoronaryCross-section75%25%IVUS培訓(xùn)LimitationsofCoronaryAngiogIrregularPlaque/IrregularLumenACross-sectionRAOViewLAOViewBCIVUS培訓(xùn)IrregularPlaque/IrregularLTheCardiovascular

ResearchFoundationLenoxHillHeartandVascular

InstituteofNewYorkIVUSEEMCSA=22.7mm2LumenCSA=16.6mm2Meanlumendiameter=4.6mmQCA9FguidingcatheterReferencediameter=3.12mmIVUS培訓(xùn)