冠状动脉血管内超声优化临界病变易损斑块诊治的研究

Coronary intravascular ultrasonography optimizes diagnosis and treatment of vulnerable plaque in intermediate stenosis

目的通过对比冠状动脉(简称冠脉)临界病变患者定量冠脉造影(quantitative coronary angiography,QCA)与血管内超声(intravascular ultrasound,IVUS)的测量结果,评价IVUS能否优化冠脉临界病变的诊断和治疗。方法通过QCA和IVUS对19名冠脉临界病变患者粥样硬化斑块处的最小管腔直径(minimal lumen diameter,MLD)、面积狭窄率(area stenosis,%AS)及直径狭窄率(diameter stenosis,%DS)等参数进行分析。应用IVUS及血管内超声-虚拟组织学(iMAP-IVUS)分析软件观察斑块类型、性质及组成成分,并对IVUS提示狭窄程度≥70%的冠脉病变行支架植入术。结果QCA与IVUS显示的MLD、%DS及%AS值分别为(1.75±0.39)mm vs(2.07±0.40)mm;(35.04±13.60)%vs(46.37±8.02)%;(52.91±15.96)%vs(62.61±11.54)%,两者比较差异均有统计学意义(P<0.05)。QCA检出合并心肌桥患者7例(36.8%),IVUS检出10例(52.6%)。采用IVUS对19例病变进行分析,其中软斑63.2%,硬斑15.8%,钙化斑块10.5%,混合斑块10.5%;偏心性斑块84.2%,向心性斑块15.8%;正性重构57.9%,无重构15.8%,负性重构26.3%。采用iMAP-IVUS对19例病变的成分进行测定,共发现TCFA14例。初步预测正性重构可能与斑块不稳定性有关。结论IVUS可提高冠脉临界病变诊断的准确率,发现易损斑块,对高危患者进行及早干预治疗,且安全性高。

Objective To determine the value of intravascular ultrasound （IVUS） in optimization of diagnosis and treatment in coronary intermediate stenosis, by comparing its results with those by quantitative coronary angiography （QCA）. Methods Clinical data of 19 patients who received QCA and identified with stenosis between 40% to 70% in our department from October 2010 to December 2011 were enrolled in this study. QCA and IVUS was used to analyze the parameters of atherosclerotic plaques in the patients with inter- mediate stenosis, such as, minimal lumen diameter （MLD）, area stenosis （% AS） and diameter stenosis （% DS）. The types, characteristics and compositions of coronary plaques were observed with the IVUS and iMAP-IVUS. Stent implantation was performed on the patient with % AS I〉70% by IVUS. Results QCA and IVUS showed that the MLD, % DS and % AS were 1.75 ~ 0.39 vs 2, 07 ＋-. 0.40 mm, （35.04 ＋ 13.60 ） % vs （46.37 ＋8.02）%, and （52.91 _ 15.96）% vs （62.61 --. 11： 54）%, respectively （P 〈0. 05）. Myocardial bridging was identified in 7 patients （36.8%） by QCA, and in 10 patients （52.6%） by IVUS. IVUS showed there were 63.2% soft plaques, 15. 8% fibrotic plaques, 10. 5% calcified plaques, and 10. 5% mixed plaques ; there were 84.2% eccentric plaques and 15.8% concentric plaques ; and there were 57.9% positive remodeling, 26. 3% negative remodeling, and 15. 8% non-remodeling, iMAP-IVUS showed there were 14 cases of thin-cap fibroatheroma （TCFA）. We presumed that positive remodeling might be associated with instability of plaques. Corlcltsion IVUS improves the accuracy of intermediate stenosis diagnosis, and easy to find out vulnerable plaque. So it is helpful to screen the patients with high risk so as to carry out early intervention and treatment,