Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound
Morphologic and angiographic features of coronary plaque rupture detected by intravascular ultrasound
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DOI：
10.1016/s0735-1097(02)02047-8
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发表时间：
2002-09-04
影响因子：
24
通讯作者：
Weissman, NJ
中科院分区：
文献类型：
--
作者：
Maehara, A;Mintz, GS;Weissman, NJ
目的探讨血管内超声(IVUS)检测斑块破裂的临床和血管造影相关性。背景：急性冠脉综合征是由斑块破裂和血栓形成引起的。在介入前的IVUS检查中发现斑块破裂。收集和/或测量标准的临床、血管造影和IVUS参数。结果在254例患者中，39例(15%)出现多处破裂，其中36例位于同一动脉。斑块破裂不仅发生在不稳定型心绞痛(46%)或心肌梗死(33%)患者，也发生在稳定性心绞痛(11%)或无症状患者(11%)。254例患者中有157例可发现纤维帽撕裂，63%发生在斑块肩部，37%发生在斑块中心。血栓多见于不稳定型心绞痛或心肌梗塞(p=0.02)和多发破裂(p=0.04)。斑块破裂部位只有28%的患者包含最小管腔面积(MLA)部位；破裂部位比MLA部位有更大的动脉和管腔面积以及更积极的重构。血管内超声斑块破裂与复杂的血管造影病变形态密切相关：溃疡占81%，内膜瓣占40%，血栓占7%，动脉瘤占7%。结论斑块破裂具有不同的临床表现，与血管造影复杂病变形态密切相关，可能是多发性的，通常不会造成管腔损害。
OBJECTIVES This study was designed to report the clinical and angiographic correlates of plaque rupture detected by intravascular ultrasound (IVUS).BACKGROUND Acute coronary syndromes result from spontaneous plaque rupture and thrombosis.METHODS We report 300 plaque ruptures in 257 arteries in 254 patients. Plaque ruptures were detected during pre-intervention IVUS. Standard clinical, angiographic, and IVUS parameters were collected and/or measured. One lesion per patient was analyzed.RESULTS Multiple ruptures were observed in 39 of 254 patients (15%), 36 in the same artery. Plaque rupture occurred not only in patients with unstable angina (46%) or myocardial infarction (MI, 33%), but also stable angina (11%) or no symptoms (11%). The tear in the fibrous cap could be identified in 157 of 254 patients; 63% occurred at the shoulder of the plaque and 37% in the center of the plaque. Thrombi were more common in patients with unstable angina or MI (p = 0.02) and in multiple ruptures (p = 0.04). The plaque rupture site contained the minimum lumen area (MLA) site in only 28% of patients; rupture sites had larger arterial and lumen areas and more positive remodeling than MLA sites. Intravascular ultrasound plaque rupture strongly correlated with complex angiographic lesion morphology: ulceration in 81%, intimal flap in 40%, thrombus in 7%, and aneurysm in 7%.CONCLUSIONS Plaque ruptures occur with varying clinical presentations, strongly correlate with angiographic complex lesion morphology, may be multiple, and usually do not cause lumen compromise.