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动脉粥样硬化是心脑血管疾病的主要病因.早期、有效地识别易损斑块是目前研究热点,对动脉粥样硬化患者的治疗和判断预后具有非常重要的临床应用价值,而斑块组份及分布与斑块易损性及其破裂后导致的心脑血管事件密切相关.本文主要从易损斑块的组份特征入手,对其影像学检测手段的进展进行简单归纳. 相似文献
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急性冠状动脉综合征(ACS)是以冠状动脉粥样硬化斑块破裂或侵袭,继发完全或不完全闭塞性血栓形成为病理基础的一组临床综合征。与稳定斑块相比,容易破裂的斑块具有明显的影像学特征:大斑块体积,低衰减斑块,餐巾指环标志,正性重构和点状钙化,这为在导致临床事件之前运用非侵入性成像识别易损斑块提供了独特的机会。随着影像技术的发展,冠状动脉CT 血管造影(CCTA)无创性评价冠状动脉易损斑块的作用已成为国内外研究热点。笔者就CCTA在评估冠状动脉斑块易损性方面的临床应用现状与进展等方面作一综述。 相似文献
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急性冠脉综合征易损斑块的研究进展 总被引:6,自引:0,他引:6
易损斑块在急性冠脉综合征(ACS)的发病及进展过程中起到重要作用,其发病机制和早期诊断是研究的热点。本文阐述了易损斑块(vulnerable plaque)的病理学特征、致病机制及相关影响因素,并对目前有创和无创影像学技术对易损斑块的早期识别的最新进展、易损斑块的血清标记物研究及易损斑块的早期干预治疗进行了综述。 相似文献
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<正>急性冠状动脉综合征(ACS)是发病率和病死率较高的心血管疾病之一,通常由易损斑块破裂继发血栓形成引起[1]。侵入性和非侵入性成像模式能够可视化冠状动脉易损斑块特征,实现精准检测的目的,现已广泛应用于冠心病患者的早期筛查、指导预防、制定个性化治疗策略等环节。1 易损斑块易损斑块具有较高的血栓形成倾向,极有可能快速进展为梗死相关动脉粥样硬化斑块。目前认为,易损斑块的基本病变特征是大斑块负荷、 相似文献
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<正>随着人们生活水平的提高,心脑血管疾病成为老年人群发病的主要疾病,其中动脉粥样硬化斑块破裂是引起血管或脏器急性栓塞的主要原因,约25%的缺血性脑卒中、70%左右的致死性心脑血管疾病与动脉粥样硬化斑块破裂有关。动脉粥样硬化斑块从稳定到易损的过程,涉及到炎症、免疫、代谢等多个过程。对斑块的检测,已逐渐从有创形态技术转为应用非创伤的影像技术,完成对易损斑块的识别[1]。分子影像学因其能准确确定斑块的组成和活性,而具 相似文献
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易损斑块(vulnerableplaque,VP)是急性冠状动脉综合征(ACS)的罪犯因子之一,早期检测、识别VP并预防其进展,对于降低ACS的发生率、致残率、病死率具有极其重要的意义。多数影像学检查几乎总是低估斑块的存在,虽然有时能提示血栓、斑块破裂及钙化,但不能提供关于斑块稳定性方面的 相似文献
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Chen WQ Zhang M Ji XP Ding SF Zhao YX Chen YG Zhang C Zhang Y 《The American journal of cardiology》2007,100(9):1341-1346
It remains unclear what kind of morphologic and biochemical features best predict plaque rupture in patients with angina pectoris (AP). This study aimed to investigate whether combined high-frequency vascular ultrasound imaging and measurements of serum inflammatory biomarkers can predict coronary plaque ruptures in patients with AP. The study population consisted of 20 patients with stable AP and 40 patients with unstable AP. High-frequency vascular ultrasound imaging was performed in the 2 groups to measure intima-media thickness, the plaque acoustic density of the common carotid arteries, and the flow-mediated dilation of the brachial arteries. Serum lipid profile and inflammatory biomarkers were measured in all patients. Using intravascular ultrasound, a list of coronary imaging parameters was obtained. A multivariate logistic regression model was applied to calculate the odds ratio of each parameter to predict coronary plaque ruptures detected by intravascular ultrasound. Of 139 coronary artery plaques identified by intravascular ultrasound, 48 plaques (9 in stable AP and 39 in unstable AP) developed ruptures. Among measured parameters, the values of carotid intima-media thickness, coronary external elastic membrane area, plaque area, plaque burden, plaque eccentric index and remodeling index, serum high-sensitivity C-reactive protein, soluble intercellular adhesion molecule-1, and soluble vascular cell adhesion molecule-1 were significantly higher in unstable AP than in stable AP (p <0.05 to 0.01). Of these parameters, carotid intima-media thickness, serum high-sensitivity C-reactive protein, and the coronary remodeling index were found to be significant predictors of coronary plaque rupture, with odds ratios of 9.51 (95% confidence interval 1.29 to 21.81), 3.02 (95% confidence interval 1.01 to 7.65), and 0.01 (95% confidence interval 0.00 to 0.34), respectively. In conclusion, combined high-frequency ultrasound imaging of coronary and carotid arteries and measurements of serum inflammatory markers are able to predict coronary plaque ruptures in patients with AP. 相似文献
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《Cor et vasa》2014,56(4):e362-e368
The term vulnerable plaque has been established to describe an atherosclerotic lesion with a high probability of causing a future coronary event [1], [2]. The identification and stabilization of the lesion before its rupture may reduce the morbidity and mortality caused by coronary artery disease. Modern imaging modalities such as computer tomography coronary angiography, intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy have a potential in finding these vulnerable plaques. This raises opportunities in the primary and secondary prevention of coronary artery disease. This review summarizes the current knowledge with an emphasis put on the research advances in the field of near-infrared spectroscopy a modality that has been intentionally developed for the detection of lipid-core plaques. 相似文献
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罪犯血管病变冠状动脉粥样斑块破裂(糜烂)和伴随的血栓形成被认为是急性冠脉综合征的主要启动机制。血管内超声是当前唯一临床上可利用的能够提供血管壁实时截面图像的技术,研究能够成像斑块形态和活性(炎症)的血管内技术是心脏病学界最近非常活跃的课题,虽然其它血管内成像技术的发展取得了重要进步,血管内超声仍然是介入心脏病专家可用的、应用最广泛的技术。 相似文献
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Vulnerable plaque: the challenge to identify and treat it 总被引:4,自引:0,他引:4
In order to understand, treat, and prevent acute coronary syndromes we need to improve our ability to identify the rupture-prone, vulnerable atherosclerotic coronary plaque. The diagnostic modalities that are currently available to clinical practice have not fulfilled this expectation, and newer diagnostic techniques based on the recently identified features of the vulnerable plaque are quite promising. Coronary angiography, intravascular ultrasound, and angioscopy have been used in the clinical arena of interventional cardiology with several limitations regarding the identification of the vulnerable plaque. Thermography, optical coherence tomography, elastography, Raman spectroscopy, and infrared spectroscopy are used in clinical trials and the results are encouraging. Ultrafast computed tomography and magnetic resonance imaging have the advantage of being noninvasive. With our progress in the identification of the rupture-prone vulnerable coronary plaque, we will be able to identify patients that are at high risk and will benefit from a more aggressive therapeutic approach. 相似文献
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Imaging of vulnerable coronary artery plaques. 总被引:3,自引:0,他引:3
Ashraf Hamdan Abid Assali Shmuel Fuchs Alexander Battler Ran Kornowski 《Catheterization and cardiovascular interventions》2007,70(1):65-74
Advances in the identification of vulnerable plaque can be an important step in preventing myocardial infarction and sudden cardiac death. The recognition that non-flow-limiting plaques often produce cardiac events has led to the development of invasive and non-invasive methods to identify such plaques prospectively. This review will present the use of noninvasive imaging modalities for identifying vulnerable plaque such as computed tomography and magnetic resonance imaging. We will also review the different invasive modalities such as intravascular magnetic resonance imaging, intravascular ultrasound, coronary angioscopy, coronary thermography, optical coherence tomography, near-infrared spectroscopy, and palpography. 相似文献
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Jonathan A. Batty Shristy Subba Peter Luke Li Wing Chi Gigi Hannah Sinclair Vijay Kunadian 《Current cardiology reports》2016,18(3):28
Coronary artery disease is the result of atherosclerotic changes to the coronary arterial wall, comprising endothelial dysfunction, vascular inflammation and deposition of lipid-rich macrophage foam cells. Certain high-risk atherosclerotic plaques are vulnerable to disruption, leading to rupture, thrombosis and the clinical sequelae of acute coronary syndrome. Though recognised as the gold standard for evaluating the presence, distribution and severity of atherosclerotic lesions, invasive coronary angiography is incapable of identifying non-stenotic, vulnerable plaques that are responsible for adverse cardiovascular events. The recognition of such limitations has impelled the development of intracoronary imaging technologies, including intravascular ultrasound, optical coherence tomography and near-infrared spectroscopy, which enable the detailed evaluation of the coronary wall and atherosclerotic plaques in clinical practice. This review discusses the present status of invasive imaging technologies; summarises up-to-date, evidence-based clinical guidelines; and addresses questions that remain unanswered with regard to the future of intracoronary plaque imaging. 相似文献
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Verheye S Diamantopoulos L Serruys PW Van Langenhove G 《Journal of cardiovascular risk》2002,9(5):247-254
The vulnerable atherosclerotic plaque is associated with an increased number of acute coronary syndromes. Current techniques such as coronary angiography are unable to detect and prospectively evaluate these lesions. Recently, other techniques, both invasive and noninvasive, are being developed trying to detect the plaque that is at increased risk for rupture eventually resulting in increased thrombosis. This review describes briefly evolving techniques for imaging of vulnerable plaques and describes in detail intravascular thermography. 相似文献
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Fukuda D Shimada K Tanaka A Kusuyama T Yamashita H Ehara S Nakamura Y Kawarabayashi T Iida H Yoshiyama M Yoshikawa J 《The American journal of cardiology》2006,97(2):175-180
Matrix metalloproteinases (MMPs) are important for resorption of extracellular matrixes and may degrade the fibrous cap of an atherosclerotic plaque, thus contributing to coronary plaque rupture. Histologic studies have shown MMP expression in lesions of acute coronary syndrome. In this study, we evaluated the relation between plaque morphology as obtained by intravascular ultrasound before percutaneous coronary intervention and serum MMP levels in patients who had coronary artery disease. We enrolled consecutive 47 patients who had acute myocardial infarction (AMI), 23 who had unstable angina pectoris (UAP), and 19 who had stable effort angina pectoris and underwent intravascular ultrasound before percutaneous coronary intervention followed by successful primary percutaneous coronary intervention. Peripheral blood was obtained from all patients before angiography and serum levels of MMP-1,-2, and -9 were analyzed. Serum levels of MMP-9 in the AMI and UAP groups were significantly higher than that in the stable effort angina pectoris group (p = 0.007 and 0.04, respectively). From the intravascular ultrasound findings before percutaneous coronary intervention, plaque rupture was detected in 26 patients (55%) in the AMI group and in 11 patients (48%) in the UAP group. In these 2 groups, patients with plaque rupture had significantly higher levels of MMP-9 than patients who did not have plaque rupture (p = 0.03 and 0.01, respectively). Multiple logistic regression analysis showed that MMP-9 was the only independent predictor of plaque rupture (p = 0.004). In conclusion, high levels of MMP-9 in patients who have AMI and UAP are related to the presence of plaque rupture in the culprit lesion. 相似文献
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Tanaka A Shimada K Sano T Namba M Sakamoto T Nishida Y Kawarabayashi T Fukuda D Yoshikawa J 《Journal of the American College of Cardiology》2005,45(10):1594-1599
OBJECTIVES: This study sought to investigate the relationship between multiple plaque ruptures, C-reactive protein (CRP), and clinical prognosis in acute myocardial infarction (AMI). BACKGROUND: Several studies have demonstrated that ruptured or vulnerable plaques exist not only at the culprit lesion but also in the whole coronary artery in some acute coronary syndrome (ACS) patients. Recent studies have reported that a ruptured plaque at the culprit lesion is associated with elevated CRP, which indicates a poor prognosis in patients with ACS. METHODS: We performed intravascular ultrasound in 45 infarct-related arteries and another 84 major coronary arteries in 45 first AMI patients. RESULTS: Plaque rupture was observed in 21 patients (47%) at the culprit site. Intravascular ultrasound revealed 17 additional plaque ruptures at remote sites in 11 patients (24%). Patients with multiple risk factors were more frequently found in our multiple-plaque rupture patients compared with single-plaque rupture or nonrupture patients (82% vs. 40% vs. 29%, p = 0.01). High-sensitive CRP levels had a positive correlation with the number of plaque ruptures (p < 0.01). All culprit lesions were successfully treated by percutaneous coronary intervention. Patients with multiple plaque rupture showed significantly poor prognosis compared with others (p = 0.01). CONCLUSIONS: Multiple plaque rupture is associated with systemic inflammation, and patients with multiple plaque rupture can be expected to show a poor prognosis. Our results suggest that AMI treatment should focus not only on stabilization of the culprit site but also a systemic approach to systemic stabilization of the arteries. 相似文献