INTRACORONARY ULTRASOUND IMAGING - CORRELATION OF PLAQUE MORPHOLOGY WITH ANGIOGRAPHY, CLINICAL SYNDROME AND PROCEDURAL RESULTS IN PATIENTS UNDERGOING CORONARY ANGIOPLASTY
INTRACORONARY ULTRASOUND IMAGING - CORRELATION OF PLAQUE MORPHOLOGY WITH ANGIOGRAPHY, CLINICAL SYNDROME AND PROCEDURAL RESULTS IN PATIENTS UNDERGOING CORONARY ANGIOPLASTY
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DOI：
10.1016/0735-1097(93)90714-c
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发表时间：
1993-01-01
影响因子：
24
通讯作者：
SHEEHAN, HM
中科院分区：
文献类型：
--
作者：
HODGSON, JM;REDDY, KG;SHEEHAN, HM
目标.本研究的目的是建立超声衍生的动脉粥样硬化形态与冠状动脉成形术患者的临床、手术和血管造影特征之间的关系。冠状动脉内超声成像提供了关于动脉腔和壁结构的准确尺寸信息。动脉粥样硬化成分也可以通过超声进行评估;然而，只有有限的研究已经在患者中进行。在65例患者中，在冠状动脉血管成形术期间使用诊断超声成像导管或组合成像-血管成形术球囊导管对病变和紧邻病变的血管段（参考段）进行成像。分析超声图像的管腔、总血管和斑块面积，并将其分为5种形态亚型（软斑块、纤维斑块、钙化斑块、混合斑块和同心内膜下增厚）。将这些数据与血管造影形态学特征、手术结果和临床心绞痛类型（稳定型与不稳定型）进行比较。从病变获得的超声图像的形态分析与临床心绞痛综合征具有良好的相关性。与稳定型心绞痛患者相比，不稳定型心绞痛患者有更多的软病变（74% vs. 41%），更少的钙化和混合斑块（纤维化、软或钙化成分的一种或多种组合[25% vs. 59%]）和更少的病灶内钙沉积（16% vs. 45%）（所有p <0.01）。对于参考节段或病变，超声和血管造影病变形态特征之间没有相关性。超声在识别不稳定病变方面的灵敏度高于血管造影（74% vs. 40%）。尺寸分析表明参考节段中存在较大的斑块负荷（占总血管面积的45 ± 15%）。血管成形术后斑块负荷也很高（62 +/-9%）。血管造影和超声测量的参考节段（r = 0.70，p <0.001）和血管成形术后病变（r = 0.63，p <0.05）的管腔面积之间存在显著相关性，但仅为中等相关性。超声斑块形态学分类与临床心绞痛密切相关，但与已建立的血管造影形态学特征关系不大。血管成形术期间的冠状动脉内超声成像可识别参考节段和病变中的大的残余斑块负荷。将来，通过冠状动脉内超声确定斑块成分可能在选择或修改介入治疗方案时很重要。
Objectives. This study was designed to establish the relation between ultrasound-derived atheroma morphology and the clinical, procedural and angiographic features of patients presenting for coronary angioplasty.Background. Intracoronary ultrasound imaging provides accurate dimensional information regarding arterial lumen and wail structures. Atheroma composition may also be assessed by ultrasound; however, only limited studies have been performed in patients.Methods. In 65 patients a diagnostic ultrasound imaging catheter or a combination imaging-angioplasty balloon catheter was used during coronary angioplasty to image both the lesion and the vessel segment just proximal to it (reference segment). Ultrasound images were analyzed for lumen, total vessel and plaque areas and were classified into five morphologic subtypes (soft, fibrous, calcific, mixed plaque and concentric subintimal thickening). These data were compared with angiographic morphologic features, procedural results and clinical angina pattern (stable vs. unstable).Results. Morphologic analysis of the ultrasound images obtained from the lesion correlated well with the clinical angina syndrome. Compared with patients with stable angina, patients with unstable angina had more soft lesions (74% vs. 41%), fewer calcified and mixed plaques (fibrotic, soft or calcific components in one or more combinations [25% vs. 59%]) and fewer intralesional calcium deposits (16% vs. 45%) (all p < 0.01). There was no correlation between ultrasound and angiographic lesion morphologic characteristics for either the reference segment or the lesion. Ultrasound demonstrated greater sensitivity than angiography for identifying unstable lesions (74% vs. 40%). Dimensional analysis demonstrated a large plaque burden in the reference segments (45 +/- 15% of total vessel area). Postangioplasty plaque burden was also high (62 +/- 9%). There was a significant, but only fair correlation between lumen area determined by angiography and ultrasound for both the reference segment (r = 0.70, p < 0.001) and the postangioplasty lesion (r = 0.63, p < 0.05).Conclusions. Morphologic plaque classification by ultrasound is closely correlated to clinical angina but has little relation to established angiographic morphologic characteristics. Intracoronary ultrasound imaging during angioplasty identifies a large residual plaque burden in both the reference segment and the lesion. In the future, determination of plaque composition by intracoronary ultrasound may be important in selecting or modifying interventional therapeutic options.