冠状动脉前降支分叉部位斑块分布的特征

Characteristics of Plaque Distribution in the Bifurcation Site of Left Anterior Descending Coronary Artery

目的应用血管内超声的方法探讨冠状动脉前降支-对角支分叉部位前降支血管内动脉硬化斑块的分布情况。方法测量53例前降支-对角支分叉病变处前降支内动脉硬化斑块的体积,将血管按照对角支的位置分为4个象限:分叉嵴侧(象限1)、心包侧(象限2)、分叉对侧(象限3)和心肌侧(象限4),比较各象限斑块的相对分布情况(各象限斑块占总斑块的体积百分比)及分叉远段与近段斑块分布的偏心性指数(象限3的斑块体积与象限1的斑块体积之比)。结果象限3的相对斑块分布最大,其次是象限4和象限2,象限1的斑块分布最小,同时象限4的相对斑块分布大于象限2。此外,分叉远段的血管狭窄程度、病变长度和斑块分布偏心性指数都要大于分叉近段。结论无论是前降支分叉远段还是近段,分叉对侧的相对斑块分布最大,而分叉嵴侧最小。此外,分叉远段的病变更加严重,且斑块分布更加不对称。

Aim To investigate the plaque distribution in the bifurcation site of left anterior descending coronary artery（ LAD） by means of volumetric intravascular ultrasound analysis. Methods The atherosclerotic plaque volumes in LAD were measured at LAD-diagonal bifurcation site in 53 cases. According to the position of diagonal branch,the vessel was divided into 4 quadrants： the carina side of bifurcation（ quadrant 1）,the pericardial side（ quadrant 2）,the opposite side of bifurcation（ quadrant 3） and the myocardial side（ quadrant 4）. The relative distribution of plaque（ the volume percent of each quadrant plaque in total plaque） was compared in each quadrant. Eccentricity index of plaque distribution（ the ratio of plaque volume in quadrant 3 to plaque volume in quadrant 1） was compared in distal and proximal bifurcation section. Results The relative volumetric plaque distribution was the largest in the quadrant 3,followed by quadrant 4 and quadrant 2,and that was the smallest in the quadrant 1. Meanwhile,relative volumetric plaque distribution in the quadrant 4 was larger than that in the quadrant 2. In addition,the degree of vascular stenosis,the length of lesion and the eccentricity index of plaque distribution in distal bifurcation section were greater than that in proximal bifurcation section. Conclusions Whatever in the distal or proximal bifurcation site of LAD,the relative plaque distribution is the largest in the opposite side of bifurcation,and the smallest in the carina side of bifurcation. Furthermore,the lesion is more serious and the plaque distribution is more asymmetric in the distal bifurcation site.