Weissman N J, Sheris S J, Chari R, Mendelsohn F O, Anderson W D, Breall J A, Tanguay J F, Diver D J
Division of Cardiology, Georgetown University Medical Center, Washington, DC 20007, USA.
Am J Cardiol. 1999 Jul 1;84(1):37-40. doi: 10.1016/s0002-9149(99)00188-5.
We sought to determine the patient and plaque characteristics associated with the different forms of arterial remodeling as seen by intravascular ultrasound (IVUS) before coronary intervention. Remodeling in response to plaque accumulation may occur in the form of compensatory enlargement and/or focal vessel contraction. Previous studies report variation in the frequency and form of arterial remodeling. We performed preintervention IVUS imaging on 169 patients. Vessels were categorized as exhibiting compensatory enlargement or focal contraction if the arterial area at the lesion was larger or smaller, respectively, than both proximal and distal reference arterial areas; otherwise the artery was considered not to have undergone significant remodeling. Calcification was assessed and noncalcified plaque density was measured by videodensitometry. Sixty-one of 169 patients (66 narrowings) (46 men and 15 women, age 56+/-11 years) had adequate reference segments. Remodeling occurred in 43 of 66 patients (65%): compensatory enlargement in 27 of 66 (41%) and focal contraction in 16 of 66 (24%). Lesions with focal contraction had significantly smaller arterial area (13.3+/-3.3 vs. 18.1+/-7.0 mm2, p = 0.02) and plaque area (9.5+/-2.8 vs 13.7+/-5.5 mm2, p<0.01). Cross-sectional stenosis was similar (71+/-9% vs. 75+/-10%, p = NS), as was plaque density (p = 0.20), eccentricity, and calcium. Patient age, gender, and lesion location were not related to the form of remodeling. Similarly, history of diabetes, hypercholesterolemia, or hypertension was not predictive. Smoking was the only risk factor associated with focal contraction (p<0.01). Thus, whereas compensatory enlargement appears to be the most common form of coronary artery remodeling, focal contraction occurs more often in smokers.
我们试图确定在冠状动脉介入治疗前通过血管内超声（IVUS）观察到的与不同形式动脉重塑相关的患者和斑块特征。因斑块积聚而发生的重塑可能以代偿性扩张和/或局灶性血管收缩的形式出现。既往研究报道了动脉重塑的频率和形式存在差异。我们对169例患者进行了介入治疗前的IVUS成像。如果病变处的动脉面积分别大于或小于近端和远端参考动脉面积，则血管被分类为表现出代偿性扩张或局灶性收缩；否则，该动脉被认为未发生显著重塑。评估钙化情况，并通过视频密度测定法测量非钙化斑块密度。169例患者中的61例（66处狭窄）（46名男性和15名女性，年龄56±11岁）有足够的参考节段。66例患者中的43例（65%）发生了重塑：66例中的27例（41%）为代偿性扩张，66例中的16例（24%）为局灶性收缩。发生局灶性收缩的病变其动脉面积（13.3±3.3 vs. 18.1±7.0 mm2，p = 0.02）和斑块面积（9.5±2.8 vs 13.7±5.5 mm2，p<0.01）显著更小。横截面狭窄情况相似（71±9% vs. 75±10%，p = 无显著性差异），斑块密度（p = 0.20）、偏心度和钙化情况也是如此。患者的年龄、性别和病变位置与重塑形式无关。同样，糖尿病、高胆固醇血症或高血压病史也无预测价值。吸烟是与局灶性收缩相关的唯一危险因素（p<0.01）。因此，虽然代偿性扩张似乎是冠状动脉重塑最常见的形式，但局灶性收缩在吸烟者中更常发生。
