CONTRIBUTION OF LOCALIZED CALCIUM DEPOSITS TO DISSECTION AFTER ANGIOPLASTY - AN OBSERVATIONAL STUDY USING INTRAVASCULAR ULTRASOUND
CONTRIBUTION OF LOCALIZED CALCIUM DEPOSITS TO DISSECTION AFTER ANGIOPLASTY - AN OBSERVATIONAL STUDY USING INTRAVASCULAR ULTRASOUND
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DOI：
10.1161/01.cir.86.1.64
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发表时间：
1992-07-01
期刊：
影响因子：
37.8
通讯作者：
YOCK, PG
中科院分区：
文献类型：
--
作者：
FITZGERALD, PJ;PORTS, TA;YOCK, PG
背景动脉粥样硬化斑块破裂和动脉壁夹层是球囊血管成形术过程的常见并发症。在球囊血管成形术期间，血管内斑块的组成和形态可能是确定斑块破裂和夹层程度的关键。为了在临床环境中检验这种潜在的联系，我们研究了球囊血管成形术后血管内超声成像的患者。41例患者在外周动脉和冠状动脉血管成形术后进行了血管内超声研究。将代表靶病变横截面的超声图像数字化，存储在计算机上，并进行离线分析。计算病灶内钙的存在和每个病灶夹层的相对大小。31例患者（76%）在球囊扩张后立即出现明显夹层或斑块破裂的超声证据。在31个病变中的23个（74%）中，超声扫描显示斑块物质内有明显的局部钙沉积。在这些病例中，87%的夹层邻近血管壁的钙化部分。此外，钙化血管（27.5+/-12.3%）与无钙化病变（11.2+/-5.8%）相比，与新腔面积相关的夹层的相对大小显著更大（p小于或等于0.002）。血管壁内钙的存在似乎与从血管壁剥离的组织臂的位置和大小显著相关。这些数据表明，局部钙沉积在促进夹层中具有直接作用，可能是通过增加斑块内的剪切应力。
Background. Atherosclerotic plaque fracture and dissection of the arterial wall are frequent concomitants of the balloon angioplasty process. The composition and morphology of plaque within the vessel may be critical in determining the extent of plaque fracture and dissection during balloon angioplasty. To examine this potential association in the clinical setting, we studied patients with intravascular ultrasound imaging after balloon angioplasty.Methods and Results. Forty-one patients were studied with intravascular ultrasound after angioplasty in both peripheral and coronary arteries. Ultrasound images representing the target lesion cross section were digitized, stored on computer, and analyzed off-tine. The presence of intralesional calcium and the relative size of dissection for each lesion was computed. Thirty-one patients (76%) had ultrasound evidence of significant dissection or plaque fracture immediately after balloon dilation. In 23 of 31 (74%) of the lesions, the ultrasound scans showed significant localized calcium deposits within the plaque substance. In 87% of these cases, the dissections were adjacent to the calcific portion of the vessel wall. In addition, the relative size of dissections referenced to the neolumen area were significantly larger (p less-than-or-equal-to 0.002) in the calcified vessels (27.5+/-12.3%) compared with the size of the dissections in lesions without calcium (11.2+/-5.8%).Conclusions. The presence of calcium within the vessel wall appeared to be significantly associated with both the location and size of the dissected tissue arm from the vessel wall. These data suggest that localized calcium deposits have a direct role in promoting dissection, presumably by increasing shear stresses within the plaque.