The relationship between coronary plaque characteristics and small embolic particles during coronary Stent implantation
The relationship between coronary plaque characteristics and small embolic particles during coronary Stent implantation
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DOI：
10.1016/j.jacc.2007.05.050
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发表时间：
2007-10-23
影响因子：
24
通讯作者：
Yoshida, Kiyoshi
中科院分区：
文献类型：
--
作者：
Kawamoto, Takahiro;Okura, Hiroyuki;Yoshida, Kiyoshi
目的探讨冠状动脉支架植入术中冠脉斑块成分与小栓塞颗粒的关系，并探讨其对冠状动脉微循环的影响。血管内超声虚拟组织学（VH-IVUS）系统（Volcano Therapeutics, Inc., Rancho Cordova, California）引入了动脉粥样硬化斑块的体内组织表征。方法对44例接受择期冠状动脉支架植入术的患者进行研究。用VH-IVUS鉴定斑块特征，用多普勒导丝检测支架植入过程中释放的小栓塞颗粒作为高强度瞬态信号（hit）。冠脉血流速度储备（CFVR）也在支架置入前后进行测量。结果根据HITS计数将患者分为三组：最低，HITS < 5 (n = 16)；中间，5 ~ 12 (n = 15)；最高的是bbb12 （n = 13）VH-IVUS鉴定的致密钙和坏死核心区在最高分位数（最低比中比最高）显著较大；致密钙：0.2 +/- 0.3 mm(2)比0.3 +/- 0.6 mm(2)比0.8 +/- 0.7 mm(2), p = 0.007；坏死核心：0.5 +/- 0.4 mm(2) VS. 0.9 +/- 0.9 mm（2) VS. 1.8 +/- 1.0 mm(2)， p分别< 0.001）。多因素logistic回归分析显示，只有坏死的核心区域是高HITS计数的独立预测因子（优势比4.41,p = 0.045）。此外，支架术后HITS计数与CFVR呈显著负相关（r = -0.35, p = 0.017）。结论VH-IVUS鉴定出的坏死核心成分与冠脉支架术中小栓塞颗粒的释放有关，导致CFVR恢复较差。
Objectives We investigated the relationship between coronary plaque components and small embolic particles during stenting and examined the influence on the coronary microcirculation.Background In vivo tissue characterization of atherosclerotic plaques was introduced by the Virtual Histology intravascular ultrasound (VH-IVUS) system (Volcano Therapeutics, Inc., Rancho Cordova, California).Methods The study consisted of 44 patients who underwent elective coronary stenting. Plaque characteristics were identified with VH-IVUS, and small embolic particles liberated during stenting were detected as high-intensity transient signals (HITS) with a Doppler guidewire. Coronary flow velocity reserve (CFVR) was also measured before and after stenting.Results Patients were divided into the tertiles according to the HITS counts: the lowest, HITS < 5 (n = 16); the middle, 5 to 12 (n = 15); and the highest, > 12 (n = 13). Dense calcium and necrotic core area identified with VH-IVUS were significantly larger in the highest tertile (lowest vs. middle vs. highest; dense calcium: 0.2 +/- 0.3 mm(2) VS. 0.3 +/- 0.6 mm(2) VS. 0.8 +/- 0.7 mm(2), p = 0.007; necrotic core: 0.5 +/- 0.4 mm(2) VS. 0.9 +/- 0.9 mm(2) VS. 1.8 +/- 1.0 mm(2), p < 0.001, respectively). Multivariate logistic regression analysis revealed only necrotic core area was an independent predictor of high HITS counts (odds ratio 4.41, p = 0.045). Furthermore, there was a significant negative correlation between the HITS count and CFVR after stenting (r = -0.35, p = 0.017).Conclusions The necrotic core component identified with VH-IVUS is related to liberation of small embolic particles during coronary stenting, which results in the poorer recovery of CFVR.