右冠状动脉起源于左冠状动脉窦走行于主肺动脉之间的血管内超声分析

Intravascular ultrasound characteristics of right coronary artery originating from the left sinus of valsalva

目的探讨右冠状动脉起源于左冠状动脉窦(RCAOL)血管内超声(IVUS)的影像学特征及RCAOL患者支架置入的可行性。方法前瞻性纳入2016年7月至2018年8月同济大学附属同济医院心内科冠状动脉造影证实RCAOL患者42例,分析RCAOL支架术前及术后即刻的IVUS影像学特征。结果 RCAOL患者42例中,男性更为多见(83.3%),典型胸痛患者占26.2%,以晕厥为首发症状的患者比例为19.0%。受压最严重节段与参考节段舒张期外弹力膜(EEM)面积比较,差异有统计学意义[(10.3±2.2)mm^2比(12.6±2.5)mm^2,P<0.001],但是管腔面积比较,差异无统计学意义[(9.5±2.3)mm^2比(10.3±1.8)mm^2,P=0.678];斑块负荷比较,差异有统计学意义[(19.7±6.0)%比(25.1±5.1)%,P<0.001]。而在受压最严重节段,收缩期受压指数(CI)较参考节段显著变化[(0.42±0.05)比(0.92±0.03),P<0.001]。从典型症状(胸痛及晕厥)患者19例与非典型症状患者23例的比较,病变长度[(8.7±1.9)mm比(6.9±1.0)mm,P<0.001]及收缩期CI(0.37±0.03)比(0.45±0.03),P<0.001]比较,差异均有统计学意义。对19例(45.2%)典型症状(胸痛及晕厥)IVUS见术后支架内横截面积较术前舒张期管腔面积,差异无统计学意义[(10.7±0.8)mm^2比(10.0±2.4)mm^2,P=0.667];但收缩期CI明显改变,较术前受压最严重节段增高,差异有统计学意义[(0.93±0.02)比(0.37±0.03),P<0.001]。结论 IVUS可动态观察RCAOL患者血管的影像特征,受压最重部位CI及受压节段长度可能是临床事件的独立预测因素。。

Objective The aim of this study was to assess the characteristics of right coronary artery originating from the left sinus(RCAOL),and the practicability of percutaneous coronary artery intervention(PCI)using intravascular ultrasound(IVUS). Methods Forty-two patients of RCAOL,identified by coronary artery angiogram were prospectively enrolled from July 2016 to August 2018 in our department. The demographic information and laboratory data were collected and IVUS parameters before and after PCI were analyzed. Results RCAOL was more common among male patients(83.3%). Compared with the distal reference segment, IVUS showed there was statistics significance of external elastic membrane(EEM)[(10.3±2.2)mm^2 vs.(12.6±2.5)mm^2,P<0.001],plaque burden(PB)[(19.7±6.0)% vs.(25.1±5.1)%,P<0.001]and the compression index(CI,the index of diameter between minor axis and major axis)[(0.42±0.05)vs.(0.92±0.03),P<0.001]between the most compressed segment and distal reference segment. In patients with typical symptoms(chest pain or syncope),there were no significance in EEM[(10.3±2.2)mm^2 vs.(9.9±2.1)mm^2,P=0.890],lumen area in systolic stage[(9.5±2.4)mm^2 vs.(9.2±2.5)mm^2,P=0.767]and PB[(20.2±6.1)% vs.(19.5±5.8)%,P=0.731],while the compression length[(8.7±1.9)mm vs.(6.9±1.0)mm,P<0.001]and CI in the most compressed segment[(0.37±0.03)vs.(0.45±0.03),P<0.001]were distinct with atypical symptom patients. In the 19 patients who underwent PCI, there was no obvious change in cross section stent area compared with pre-operation[(10.7±0.8)mm^2 vs.(10.0±2.4)mm^2,P=0.667]. However, there was a markedly improvement of CI after stent implantation[(0.93±0.02)vs.(0.37±0.03),P<0.001]. Conclusions IVUS could provide more dynamic characteristics of RCA vessel. CI in the most compressed segment and the length of compression may be the independent risk factors.