冠状动脉分叉病变的血管内超声虚拟组织学影像特点

The intravascular ultrasonographic virtual histology features of the coronary bifurcation lesions

目的采用血管内超声(IVUS)和血管内超声虚拟组织学(IVUS-VH)检查方法分析冠状动脉分叉处斑块的影像学特点。方法收集2006年6月-2011年10月行选择性冠脉造影检查患者147例,用IVUS和IVUS-VH分析患者冠状动脉分叉近端、远端以及分叉处的对侧和内侧斑块负荷及其组成成分。结果冠状动脉分叉处血管对侧壁的斑块负荷百分数为47%±14%,大于内侧壁的35%±11%,组间差异有统计学意义(P<0.01)。分叉血管对侧壁的钙化成分为34%±31%,亦大于内侧的22%±21%,组间差异有统计学意义(P<0.01)。结论冠状动脉分叉对侧低剪切力血管处动脉粥样硬化斑块负荷重,且动脉粥样硬化斑块中钙化成分比例较高。

Objective To analyze the morphology and composition of the regional plaque located at the coronary artery bifurcation by using intravascular ultrasound （IVUS） and virtual histology （IVUS-VH） technique. Methods Selective eoronary angiography was performed in a total of 147 patients during the period from June 2006 to Oct. 2011. The clinical data were collected. By using IVUS and IVUS-VH technique, the segmental plaque burden, together with the composition, located at the proximal, distal segments and bifurcation of the coronary arteries were analyzed. Results The relevant data were obtained in all 147 patients. At the coronary bifurcation, the percentage of the opposite vessel wall plaque burden was （47 ± 14）%, which was higher than that of the medial vessel wall plaque burden （35 ± 11）%, the difference was statistically significant （P 〈 0.01 ）. In addition, at the coronary bifureation the calcified contents of the opposite vessel wall plaque was （34 ±31 ） %, which was higher than that of medial vessel wall plaque （22 ± 21 ）%, the difference was statistically significant （P 〈 0.01 ）. Conclusion The plaque located at the opposite wall of the eoronary bifurcation, which is the region with low shear stress, not only exhibits a higher plaque burden, but also has a higher degree of calcification. （J Intervent Radiol, 2012, 21 ： 274-277）