摘要
目的:Glagov的病理组织学所见和非系列血管内超声研究(IVUS)推断:当动脉粥样斑块负荷达到40%时,代偿性冠状动脉重构便会减少。作者应用系列IVUS对此假设进行检验。方法与结果:应用系列IVUS检查了46例无狭窄的粥样硬化冠状动脉左主干(时间间隔18±8个月),对结果进行分析以评估基线斑块负荷[(斑块面积+中膜面积)/血管面积]和系列重构(基线时血管面积-随访时血管面积)的关系。共有25例基线斑块负荷【40%(30.1%±6.6%,A组),21例基线斑块负荷≥40%(46.1%±5.8%,B组)。
Aims: Glagov's histopathological observation and non-serial intravascular ultrasound studies (IVUS) concluded that compensatory coronary remodelling diminishes as 40%atherosclerotic plaque burden is reached. We tested this hypothesis with serial IVUS. Methods and results: Serial IVUS examinations of 46 atherosclerotic non-stenotic left main stems (18±8 months apart) were analysed to assess the relation between baseline plaque burden(=plaque+media area/vessel area) vs. serial remodelling(=vessel area at baseline-at follow-up). There were 25 plaques with baseline plaque burden< 40%(30.1±6.6%, group A) and 21 plaques with baseline plaque burden ≥40%(46.1±5.8%, group B). There was no relation between baseline plaque burden vs. subsequent changes in vessel area overall (r=0.07, P=0.7), for group A (r=0.03, P=0.6), and group B (r=0.01, P=0.8). The frequency of positive serial remodelling (vessel area increase) vs. negative or intermediate serial remodelling (no change or decrease) were similar in group A[17(68%) vs. 8(32%)] and group B lesions[18(86%) vs. 3(14%)](P=0.2). Conclusion: IVUS demonstrates that serial coronary remodelling is not related to baseline plaque burden. Lesions with baseline plaque burden< 40%may subsequently show a lack of compensation or frank arterial shrinkage, whereas lesions with baseline plaque burden >40%may continue to develop compensatory enlargement.
