Effect of atrovastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome

To evaluate the effect of atrovastatin therapy on borderline vulnerable lesions in patients with acute coronary syndrome (ACS) .Methods Patients with ACS underwent coronary angiography (CAG) and intravascular ultrasound (IVUS) investigation.Patients with culprit vulnerable borderline lesions were enrolled.No coronary inter-vention was performed on these lesions.All the patients received atrovastatin therapy for 12 months and underwent clin-ical follow-up along with IVUS follow-up.Cross section area (CSA) of the targeted lesion,CSA of the reference arter-ies (extra elastic membrane) ,minimal lumen CSA,and plaque area were measured at baseline and follow-ups.Ad-verse events included recurrent angina,recurrent myocardial infarction,revascularization and death.Results No ad-verse events was reported during follow-up period.Compared with baseline data,the level of ApoB decreased signifi-cantly at the end of the study (0.589 ± 0.136 g /L vs 0.681 ± 0.132 g /L,P = 0.03) .Both the percent diameter steno-sis and the percent area stenosis detected by CAG displayed minimal change ((62.50 ± 10.21) % vs (54.79 ± 12.35) % ,P = 0.48 and (58.61 ± 8.36) % vs (48.18 + 10.56) % ,P = 0.78) .Detected by IVUS,the minimal lu-minal CSA of the targeted lesion increased significantly (6.32 ± 2.42 mm2 vs 5.63 ± 2.51 mm2,P 0.01) ,the plaque area and CSA stenosis decreased (7.70 ± 2.19 mm2 vs 8.17 ± 2.55 mm2,P 0.05 and 56.94 ± 8.47% vs 61.4 ± 110.34% ,P 0.01) .A total of 25 soft plaques (50% ) transformed into fibrous plaque.Conclusions Atro-vastatin therapy stabilizes borderline vulnerable plaque and reverses atherosclerosis progression in patients with ACS.     

Relationship between interleukin-18 levels and characterization of atherosclerotic plaque and percutaneous coronary intervention

Background lnterleuldn-18(IL- 18) plays a key role in the development,progression and outcome of coronary artery disease and its complications.However,its variability relation to the characterization of atherosclerotic plaque and percutaneous coronary intervention are still unknown.Methods Fifty four patients with coronary artery disease [22 patients with stable angina (SA) and 32 patients with acute coronary syndrome (ACS)] were enrolled in this study.All patients underwent percutaneous coronary intervention (PCI).The stability of the plaques at the criminal vessels was assessed with analogical IVUS.Serum IL-18 levels were measured at the time points of 5 rain before PCI,and Oh,6h,24h and lmonth after PCI in all patients.Results ACS group consisted mainly of lipidic unstable plaques while SA group of fibrous stable plaques.Moreover,compared with those in SA group,eccentricity index (EI) and remodeling index (RI) were significantly higher in ACS group.Positive remodeling was seen in ACS group while negative or no remodeling in SA group.Further,serum IL-18 levels were significantly elevated in patients with ACS than those in SA group before PCI,increased at Oh,6h,24h after PCI (P＜0.05)and were not significant different at 1 month after PCI from those before PCI.Conclusions There is significant difference in the composition and structural characteristics of atherosclerotic plaques between ACS and UA groups.PCI triggersd and enhances the inflammatory response in a short time.Serum levels of IL- 18 are the predictors of progression of unstable plaque in atherosclerosis.Post-operative complications of PCI might be reduced by inhibiting IL- 18.(J Geriatr Cardiol 2008;5:21-24)     

The early evaluation value of microRNA-30a for patients with acute coronary syndrome

Plasma levels of Micro RNA-30 a(mi R-30 a) were found to be increased in acute coronary syndrome(ACS) patients. Hence, the purpose of this study was to explore the possibility of using plasm mi R-30 a as biomarkers of ACS and to further investigate whether these levels were associated with the lesion characteristic based on the intravenous ultrasound(IVUS). Methods 176 patients, divided into stable angina(SA) group(n=84) and ACS group(n=92), were enrolled. Lesion characteristics and remodeling index(RI) were detected by IVUS and plasma levels of mi R-30 a by real-time PCR. Associations among lesion characteristics, plasma levels of mi R-30 a and RI were analyzed. Results Compared with SA group, RI(0.90±0.03 vs. 1.15±0.05, P0.001)were significantly higher in the ACS group. In the ACS group, the level of plasma mi R-30 a [(11.66±1.19) 2~(-ΔΔct*)104 vs.(8.10±1.09) 2~(-ΔΔct*) 104, P0.001] was significantly higher than the SA group. The receiver operating characteristic curve showed that plasma mi R-30 a had feasible predictive value for ACS(area under curve: 0.845, 95%confidence interval: 0.765-0.924, P0.001). Plasma mi R-30 a levels was positively related to RI(r=0.817, P=0.001). Moreover, the plasma mi R-30 a levels was significantly lower in cases with negative remodel, fibrotic plaque and calcified plaque, while it was higher in cases with positive remodeling. Conclusions Coronary positive remodeling occurs in patients with ACS. Plasma mi R-30 a level might be used as early evaluation index of coronary atherosclerosis in patients with ACS. [S Chin J Cardiol 2021;22(3):154-160]     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

Objective To identify underlying mechanical risk factors of that developed in-stent restenosis (ISR) or early stent thrombosis in sirolimus-eluting stent (SES)-treated lesions using intravascular ultrasound (IVUS). Methods IVUS were performed in 60 (ISR, n = 43; early stent thrombosis, n = 17) patients (event group) and in 34 patients without ISR and early stent thrombosis (noevent group) underwent SES implantations. Results Compared with the no-event group, minimum stent area [MSA, (4.6±1.6) mm2 vs. (5.8±1.6) mm2, P ＜0.01], minimum stent diameter [(2.2±0.5) mm vs. (2.5±0.4) mm, P＜0.01],andstentexpansion[(69.2±20.7)% vs. (80.6±17.2)%,P＜ 0.01] were significantly smaller, and longitudinal stent symmetry index (MSA/maximum stent area, 2.0±0.6 vs. 1.7±0.6, P ＜ 0.05) was significantly larger in the event group. Incidence of MSA ＜ 4.0 mm2(43.3% vs. 14.7%, P ＜0.01) and stent expansion ＜60% (40.7% vs. 11.8%, P ＜0.01) were more frequent in the event group than that in no-event group. Furthermore, proximal residual plaque burden was significantly higher compared to the no-event group [(49.0±15.5) % vs. (38.4±17.6) %, P ＜ 0.01]. Independent predictors of post SES 1SR or early thrombosis were MSA (OR:0.7, 95% CI:0.5-0.8, P ＜ 0.01) and proximal residual plaque burden (OR:280.7, 95% CI: 17.2-40 583.6, P ＜ 0.01). Conclusion Smaller MSA and higher proximal residual plaque burden are independent predictors of ISR or early thrombosis post SES implantations.     

左主干冠状动脉病变的血管内超声研究

目的 血管内超声评价非严蕈钙化性左主干病变的形态特点,探讨开口和非开口部位形成狭窄的不同机制.方法 2004年10月至2007年10月,共入选造影确诊或可疑的狭窄病变并行血管内超声检查的153例(开口47例,非开口106例)非严重钙化性左主干病变,定性和定量分析血管内超声图像;负性重构定义为重构指数＜0.95.结果 左主干参考节段平均管腔直径和血管(外弹力膜)直径为(4.1±0.8)mm和(5.3士0.8)mm.开口病变的纤维性、钙化性和软斑块分别为70.2%、19.2%和8.5%,而非开口病变为35.8%、43.4%和3.8%,两者差异有统计学意义(P=0.01).总体来说,31.1%病例的最小管腔面积＜6 mm2,其中开口组29.5%,非开口组31.9%(P=0.87).最小管腔面积在两组相似,但非开口组的斑块面积[(13.3±5.4)mm2比(10.8±4.5)mm2,P=0.007]和斑块负荷(61.9%±14.5%比54.8%±15.9%,P=0.020)均显著大于开口组,斑块负荷＞50%的比例更高(84.8%比61.3%,P=0.002).开口病变的重构系数显著低于非开口病变(0.9±0.2比1.0.±0.2,P=0.000),而且负性重构更多见(74.5%和34.9%,P=0.000).logistic回归分析发现,病变部位(OR=4.9,P=0.004)、斑块面积(OR=1.2,P=0.01)和斑块负荷(OR=0.003,P=0.000)是左主干发生重构的独立预测因素.结论 负性重构现象在左主干开口病变中更常见,可能是其狭窄形成的机制之一.狭窄程度不确定的冠状动脉左主干病变需要血管内超声精确评价.     

血管内超声评价雷帕霉素洗脱支架再狭窄及早期血栓形成

目的 以血管内超声评价雷帕霉素洗脱支架置人术后发生支架内再狭窄及血栓形成的机械性危险因素.方法 对雷帕霉素洗脱支架置入术后发生支架内再狭窄或早期(≤30 d)血栓形成的60例患者(事件组)及无支架内再狭窄和早期血栓形成的34例患者(无事件组)的血管内超声资料进行分析比较.结果 事件组发生支架内再狭窄43例,早期血栓形成17例.与无事件组比较,事件组的最小支架面积(MSA)[(4.6±1.6)mm2比(5.8±1.6)mm2,P＜0.01]、最小支架直径[(2.2±0.5)mm比(2.5±0.4)mm,P＜0.01]和支架扩张率[(69.2±20.7)%比(80.6±17.2)%,P＜0.01]较小、纵向支架对称性较差(2.0±0.6比1.7±0.6,P＜0.05).MSA＜4 mm2(43.3%比14.7%,P＜0.01)和支架扩张率＜60%(40.7%比11.8%,P＜0.01)在事件组较常见.与无事件组比较,事件组的近段残余斑块负倚较大[(49.0±15.5)%比(38.4±17.6)%,P＜0.01].Logistic回归分析显示,MSA(OR:0.7,95%CI:0.5～0.8,P＜0.01)和近段残余斑块负荷(OR:280.7,95%CI:17.2～40 583.6,P＜0.01)是药物洗脱支架发生再狭窄或早期血栓形成的独立预测因素.结论 较小的MSA和较重的近段残余病变易导致雷帕霉素洗脱支架发生支架内冉狭窄及早期血栓形成.     

急性冠状动脉综合征患者雷帕霉素洗脱支架晚期贴壁不良及其对临床预后的影响

目的 观察急性冠状动脉综合征(ACS)患者雷帕霉素洗脱支架晚期贴壁不良发生率及其对临床预后的影响.方法 观察2005年2月至2007年3月因ACS(ACS组,54例)和稳定性心绞痛(对照组,83例)行雷帕霉素洗脱支架治疗并于1年后行血管内超声检查患者,检测支架晚期贴壁不良发生率,并观察血管内超声检查后1年内主要不良心血管事件及支架内血栓发生率.结果 所有137例患者219处病变中,16例患者25处病变检测到晚期支架贴壁不良.25处晚期支架贴壁不良中ACS组和对照组分别为20处(22.2%)和5处(3.9%)(P＜0.001).两组患者参照血管外弹力膜面积、参照血管和支架段血管管腔面积和新生内膜面积均相似,但ACS组患者支架段血管外弹力膜面积[(15.34±5.44)mm2比(13.83±4.51)mm2,P=0.026]、支架段血管外弹力膜面积与参照血管外弹力膜面积比值(1.13±0.22比1.02±0.18,P＜0.001)、斑块和中膜面积[(8.43±3.93)mm2比(7.01±2.93)mm2,P:0.002]较对照组明显增大.Logistic多元回归分析显示,ACS(OR=6.477,P＜0.001)和支架长度≥23 mm(OR=3.680,P=0.025)为晚期支架贴壁不良的独立危险因素.血管内超声检查后临床随访1年,两组主要不良心血管事件发生率差异无统计学意义.结论 雷帕霉素洗脱支架置入后,ACS患者较稳定性心绞痛患者更多发生晚期支架贴壁不良,然而随访1年的主要不良心血管事件发生率差异无统计学意义.     

国产与进口西罗莫司洗脱支架置入后血管内超声随访的对比

目的 利用血管内超声对比观察国产与进口西罗莫司洗脱支架对冠心病患者支架术后新生内膜增生的抑制作用.方法 2003年5月至2007年3月,对215例冠心病患者(317处病变)置入西罗莫司洗脱支架,并在术后1年行冠状动脉造影和血管内超声(IVUS)检查.其中Firebird组108例患者(147处病变)置入国产西罗莫司洗脱支架(Firebird支架),Cypher组107例患者(138处病变)置入进121西罗莫司洗脱支架(Cypher支架).结果 两组患者一般临床情况差异无统计学意义.两组靶病变部位、病变长度、狭窄程度及病变类型差异均无统计学意义,但Firebird组术后最小管腔直径大于Cypher组[(2.88±0.43)mm比(2.78±0.33)mm,P＜0.05].随访定量冠状动脉造影分析显示,Firebird组与Cypher组支架内晚期管腔丢失[(0.17±0.29)mm比(0.16±0.27)mm,P＞0.05]和节段内晚期管腔丢失[(0.18±0.36)mm比(0.20±0.32)mm,P＞0.05]差异均无统计学意义.IVUS分析显示,与Cypher组比较,尽管Firebird组支架面积[(6.99±2.25)mm~2比(6.46±1.71)mm~2,P＜0.05]、管腔面积[(6.89±2.30)nm~2比(6.36±1.73)mm~2,P＜0.05]、支架体积[(162.5±68.9)mm~3比(140.8±57.9)mm~3,P＜0.01]、管腔体积[(160.4±69.5)mm~3比(138.6±57.6)mm~3,P＜0.01]及最小支架面积[(5.40±1.85)mm~2比(4.92±1.43)mm~2,P＜0.05]均较大,但两组的内膜增生容积[(2.09±5.46)mm~3比(2.23±6.50)mm~3,P＞0.05]和内膜增生容积百分数[(1.68±5.84)%比(1.59±4.10)%,P＞0.05]差异均无统计学意义.结论 Firebird支架置人后再狭窄的发生率较低,抑制内膜增生作用与Cypher支架相似.     

冠心病支架内再狭窄患者血浆脂联素水平的观察

目的 观察冠心病患者支架置入术后再狭窄与血浆脂联素水平之间的关系.方法 对65例支架置入术后9～12个月无支架内再狭窄(A组)和54例存在支架内再狭窄≥50%(B组)的冠心病患者进行研究,复查冠状动脉造影当天取空腹12 h以上的股动脉血,采用ELISA法测定血浆脂联素水平;同时对支架置入前、置入术后即刻及9～12个月后的冠状动脉造影结果进行QCA评价.结果 A、B两组的靶血管病变部位及病变的复杂程度均相似,使用金属裸支架分别为8例(12.31%)和6例(11.11%);使用紫杉醇药物洗脱支架分别为11例(16.92%)和10例(18.52%);使用雷帕霉素药物洗脱支架分别为46例(70.77%)和38例(70.37%),术后用药两组之间无明显差异.A组脂联素水平明显高于B组[(15.16±5.02)mg/L比(10.01±4.93)ms/L,P<0.05];两组的病变长度相似[(15.82±6.67)mm比(13.40±4.20)mm,P>0.05];术前及术后即刻的最小管腔直径(MLD)、狭窄程度两组差异无统计学意义(P>0.05),但9～12个月时的QCA显示:A组的MLD为(2.55±0.53)mm,平均狭窄程度为(24.21±11.23)%,B组的MLD为(0.57±0.60)mm,平均狭窄程度为(81.00±19.11)%,P<0.01;即刻获得的管腔直径两组间比较无统计学意义[(1.48±0.65)mm 比(1.19±0.37)mm,P>0.05];A组的晚期丢失明显小于B组[(0.50±0.34)mm比(1.60±0.54)mm,P<0.01].结论 血浆脂联素水平降低可能是支架术后再狭窄的原因之一.     

他汀类药物对轻度胆固醇升高2型糖尿病患者冠状动脉粥样硬化斑块和重构的影响

目的 评价他汀类药物对轻度胆固醇升高合并糖尿病的冠心病患者冠状动脉粥样硬化斑块和重构的影响.方法 将2003年4月至2007年4月住院的78例合并2型糖尿病的稳定性心绞痛患者分为2组:他汀类药物治疗组(他汀组)40例;非他汀类药物治疗组(非他汀组)38例.入组时,两组患者低密度脂蛋白胆固醇(LDL-C)为2.6～3.6 mmol/L.每例患者选取1处狭窄为50%～70%的病变为靶病变.入组时和12个月后分别行冠状动脉造影(CAG)和靶病变以及参考段的血管内超声(IVUS),比较治疗前后斑块体积、管腔体积、血管体积和冠状动脉的重构指数(RI).结果 他汀组12个月后,平均LDL-C由(3.52±0.56)mmol/L降至(2.41±0.33)mmol/L(P<0.05),较入组时下降31.5%;非他汀组平均LDL-C较入组时差异无统计学意义[(3.50±0.49)mmol/L比(3.55±0.70)mmol/L,P>0.05].血管体积、管腔体积和斑块体积在入组时两组差异无统计学意义.与入组时比较,12个月后非他汀组斑块体积显著增加19.7%[(76.1±13.0)mm3比(95.0 ±21.9)mm3,P<0.05],血管体积差异无统计学意义,管腔体积由(65.0±10.9)mm3减少至(45.4±6.6)mm3,P<0.05.他汀组的斑块体积增加10.1%[(79.5±15.2)mm3比(87.5±17.9)mm3,P<0.05]、血管体积增加7.0%[(148.2±40.9)mm3比(158.5 ±53.1)mm3,P>0.05]、管腔体积无明显变化.非他汀组治疗前后RI差异无统计学意义(0.93±0.08比0.92±0.09,P>0.05),而在他汀组RI由0.91±0.08增加至0.95±0.10(P<0.05).结论 他汀类药物可以延缓LDL-C轻度升高合并糖尿病的冠心病患者冠状动脉斑块的进展,且可使病变部位血管体积增大、负性重构减轻,甚至可以使部分冠状动脉重构类型发生变化.     

冠状动脉前降支近段临界靶病变的血管内超声影像学特点研究

目的 研究前降支近段临界靶病变的血管内影像特点,为治疗该类病变提供依据。方法 收集2010年6月至2011年10月沈阳军区总医院诊治的10例冠心病患者,造影显示前降支存在临界病变,直径狭窄程度30%～50%,其中男性7例,10例患者均有不同程度的心前区不适感,同时伴有糖尿病者2例,高血压者3例,高胆固醇血症者1例,有吸烟史者2例,既往有心肌梗死病史者2例。对症状典型的患者,行血管内超声检查,明确斑块分布情况后行介入治疗,对症状不典型的患者,先行运动负荷试验,阳性者血管内超声检查后行介入治疗。结果 10例经介入治疗患者临床症状均消失,最小血管管腔面积为(4.85±1.49)mm2,其中大于4 mm2共7例,占70%;斑块面积负荷为(69.99±7.07)%,其中小于70%共4例,占40%。结论 在前降支近段,以最小管腔面积4 mm2或斑块面积负荷70%作为判断是否应行介入治疗的界值是不可靠的,血管内超声检查结果结合患者临床情况有助于准确选择治疗策略。     

Mechanism of cutting balloon angioplasty for in-stent restenosis: an intravascular ultrasound study.

We investigated by intravascular ultrasound (IVUS) the mechanism of action of cutting balloon (CB) angioplasty in patients with in-stent restenosis. Seventy-one consecutive restenotic lesions of 66 patients were studied by quantitative coronary angiography (QCA) and IVUS before, immediately after, and, in 20 cases, at 24-hr time interval after CB. CB was selected according to 1:1 CB-to-stent ratio and inflated at 8 atm for 60-90 sec. Both IVUS planar and volumetric (Simpson's rule, 25 patients) analysis were carried out. IVUS measurements included external elastic membrane area (EEMA), stent area (SA), minimal lumen area (MLA), and restenosis area (RA). Following CB, QCA analysis showed increase of minimal lumen diameter (1.17 +/- 0.46 vs. 2.45 +/- 0.51 mm; P < 0.0001) and decrease of diameter stenosis (64% +/- 13% vs. 21% +/- 9%; P < 0.0001). IVUS measurements showed a significant increase of MLA (2.18 +/- 0.80 vs. 7.31 +/- 1.8 mm(2); P < 0.0001), SA (9.62 +/- 2.6 vs. 10.7 +/- 2.75 mm(2); P < 0.0001), and EEMA (17.27 +/- 5 vs. 18.1 +/- 5 mm(2); P < 0.0001) and a decrease of RA (7.43 +/- 2.63 vs. 3.45 +/- 1.39 mm(2); P < 0.0001). No significant change was observed in the original plaque + media area (7.65 +/- 3 vs. 7.38 +/- 2.9 mm(2); P = NS). Thus, of the total lumen enlargement (5.13 +/- 1.85 mm(2)), 23% was the result of increase in mean SA, whereas 77% was the result of a decrease in mean RA. These changes were associated with a 5% increase in EEMA. IVUS volumetric changes paralleled planar variations. Angiographic and IVUS changes were well maintained at 24 hr. CB enlarges coronary lumen mainly by in-stent tissue reduction associated with a moderate degree of additional stent expansion. Favorable QCA and IVUS acute results are maintained at 24 hr.     

冠状动脉临界病变血管内超声检查参数与定量血流分数的相关性研究

目的探讨冠状动脉临界病变血管内超声(IVUS)检查参数与定量血流分数(QFR)的相关性。方法前瞻性连续入选2018年9月至2019年9月于同济大学附属东方医院接受QFR和IVUS检查的116例患者(117处冠状动脉临界病变)。根据QFR评估结果,将患者分为QFR≤0.80组(25处病变)和QFR>0.80组(92处病变),比较两组IVUS检查参数的差异。应用Poisson线性相关性分析以及受试者工作特征(ROC)曲线评估IVUS与QFR的相关性,应用logistic多元回归分析QFR≤0.80的预测因素。结果IVUS检查发现,QFR≤0.80组最小管腔面积(MLA)[(3.1±0.8)mm²比(3.6±1.1)mm²,P=0.040]、最小管腔直径(MLD)[(1.8±0.3)mm比(2.0±0.3)mm,P=0.012]显著小于QFR>0.80组,而斑块负荷[(73.5±5.6)%比(68.0±8.4)%,P=0.002]、面积狭窄率[(69.8±8.8)%比(63.8±9.8)%,P=0.007]、斑块偏心指数[(0.83±0.12)比(0.73±0.19),P=0.008]及回声消减斑块比例(52.0%比23.9%,P=0.003)显著高于QFR>0.80组,差异均有统计学意义。Poisson线性相关分析显示,MLA(r=0.259,P=0.005)、MLD(r=0.300,P=0.001)与QFR正相关,而斑块负荷(r=–0.357,P<0.001)以及斑块偏心指数(r=–0.247,P=0.008)与QFR负相关。logistic多因素回归分析表明斑块负荷>70%(OR 4.531,95%CI 1.443~14.222,P=0.010)和斑块偏心指数(OR 1.066,95%CI 1.014~1.121,P=0.012)为QFR≤0.80的独立预测因素。结论冠状动脉临界病变IVUS检查结果中斑块负荷>70%以及斑块偏心指数是QFR≤0.80的独立预测因子。     

支架影像增强显影技术及其对球囊后扩张的指导作用

目的:探讨支架影像增强显影技术(StentBoost,SB)增强冠状动脉(冠脉)支架显影以及对球囊后扩张的指导作用。方法:收集2009-03至2010-07经皮冠脉介入治疗(PCI)术后在SB指导下给予球囊后扩张的184例患者资料,平均年龄(64.5±10.9)岁(42～83岁),对其后扩张前后SB测量数据进行比较。其中52例(28.26%)患者给予血管内超声(IVUS)检查,并分别对冠脉狭窄程度定量分析(QCA)、IVUS和SB检测数据进行相关性分析。结果:后扩张后较后扩张前支架内最小直径[(2.72±0.35)mm vs.(2.42±0.39)mm]、支架内最大直径[(3.26±0.37)mm vs.(3.09±0.38)mm]及支架内平均直径[(2.99±0.36)mm vs.(2.76±0.43)mm]均明显增大,支架偏心指数(0.17±0.04 vs.0.22±0.06)明显减小,差异均有统计学意义(P<0.001)。支架内最小直径IVUS与SB的相关性r=0.979,P<0.0001;冠脉狭窄程度定量分析与SB的相关性r=0.973,P<0.0001;QCA与IVUS的相关性r=0.964,P<0.0001。结论:SB与IVUS具有良好的相关性,且在评价支架置入效果以及指导高压球囊后扩张方面具有临床实用价值。