Читать книгу Interventional Cardiology - Группа авторов - Страница 216

Coronary angiography depicts the coronary anatomy as a longitudinal silhouette of the lumen. Conversely, IVUS with its tomographic perspective directly images the lumen, atheroma, and the vessel wall. Coronary angiography significantly underestimates the presence, severity, and extent of atherosclerosis compared to IVUS [4–6]. Furthermore, IVUS routinely shows significant atherosclerosis in angiographically “normal” segments in patients undergoing PCI [11]. This phenomenon may be explained by three major factors: (i) coronary atherosclerosis is often diffusely distributed involving long segments of the vessel containing no truly normal reference segment for comparison, (ii) complex atherosclerotic plaques are not appreciated by the two‐dimensional “silhouette”, and (iii), most importantly, the presence of arterial wall remodeling [4,5]. In some circumstances diffuse, concentric, and symmetrical coronary disease can affect the entire length of the vessel resulting in an angiographic appearance of a small artery with minimal luminal narrowing.