冠状动脉造影模糊病变的血管内超声影像分析

Intravascular ultrasound assessment of the causes of coronary angiographic hazy lesions

目的探讨血管内超声（IVUS）对冠状动脉造影病因不确定的模糊病变的价值。方法从2009年7月至2010年3月连续选取25例诊断性冠状动脉造影或冠状动脉介入术后造影提示存在模糊病变者，模糊病变定义为血管造影上局部的造影剂密度降低，并排除明确的内膜撕裂、夹层、血栓或狭窄（〉50％）等情况，对其行IVUS检查，根据检查结果选择相应的处理策略。结果25例患者所有管腔横截面积（CSA）均〉4．0mm^2。12例模糊病变位于前降支，6例位于右冠状动脉，5例位于回旋支，2例位于左主干。IVUS影像分析结果2例正常或接近正常，10例为钙化，5例为斑块破裂，3例为偏心斑块，2例为血栓，2例为夹层，1例为内膜下血肿。对其中的7例患者行支架置入术。所有患者住院期间无心血管事件发生。结论近一半的血管造影模糊病变与管壁钙化或偏心的钙化斑块有关，IVUS能有效识别造成模糊病变的不同病变性质，避免了不必要的支架置入。

Objective To identify the causes of coronary angiographic hazy lesions by intravascular ultrasound （IVUS） to avoid inappropriate stenting. Methods Twenty-five cases with hazy regions on coronary angiogram were consecutively identified from July 2009 to March 2010. Hazy regions were defined by coronary arteriongraphy as reduced contrast density without a clearly defined intimal tear, dissection, thrombus, or stenosis （ 〉 50% ）. This cohort of patients were subsequently underwent IVUS examinations and treated according to the results of IVUS. Results The lumen CSAs were settled as 〉 4.0 mm^2 in all examinations. Among all 25 cases, hazy lesions were located in left anterior descending in 12 patients, right coronary artery in 6 patients, left circumflex in 5 patients, and left main artery in 2 patients. According to the IVUS findings, 2 cases showed absolutely normal or near-normal arterial wall structure image, 10 cases showed calcified plaque,5 cases showed plaque rupture ,3 cases showed eccentric plaque ,2 cases showed thrombosis formation,2cases showed dissection, 1 case showed subintimal hematoma. Seven patients received stent implantation, and the rest accepted medical therapy. There were no in-hospital MACEs reported among all patients. Conclusion Nearly half of the coronary arteriongraphic hazy lesions were caused by calcified plaque. IVUS can distinguish calcified plaques from intimal tears, thrombus and other underlying etiologies, and help to avoid unnecessary stenting.