Kinlay S
Intravascular Ultrasound, Cardiac Catheterization Laboratory, Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street, Boston, MA 02115, USA.
Curr Atheroscler Rep. 2001 May;3(3):260-6. doi: 10.1007/s11883-001-0069-9.
Intravascular ultrasound (IVUS) has a defined role in the cardiac catheterization laboratory to assess lesion severity and the procedural success of vascular interventions. However, IVUS has also contributed to our understanding of the biology of atherosclerosis and restenosis. In acute coronary syndromes, IVUS has revealed varying degrees of stenosis, thrombosis, and plaque derangement typical of the plaque disruption seen in many pathologic studies of patients who have died of this condition. IVUS has demonstrated that the culprit lesions of patients surviving acute coronary syndromes also tend to be softer, with less calcium, and tend to have more plaque with positive arterial remodeling (compensatory enlargement) than lesions causing stable coronary syndromes. Arterial remodeling is also an important component of restenosis after coronary interventions. IVUS has suggested that interventions that reduce restenosis tend to have a greater impact on preventing negative remodeling (constriction) rather than reducing neointimal proliferation. Oxidant stress may be an important contributor to negative remodeling, as IVUS has demonstrated this anatomy at sites of coronary artery spasm. Positive remodeling seen by IVUS is also associated with impaired endothelial vasomotor dysfunction, and IVUS studies have demonstrated the contribution of vasomotor tone to arterial elasticity. Future directions include integrating IVUS with other imaging modalities, such as angiography, to study the interaction of anatomic and physiologic factors in atherosclerosis progression, and using the raw ultrasound signal to distinguish plaque components and differences in wall strain that may identify vulnerable plaques.
血管内超声（IVUS）在心脏导管实验室中具有明确的作用，可用于评估病变严重程度和血管介入手术的成功率。然而，IVUS也有助于我们对动脉粥样硬化和再狭窄生物学的理解。在急性冠状动脉综合征中，IVUS揭示了不同程度的狭窄、血栓形成和斑块紊乱，这是许多死于这种疾病的患者病理研究中典型的斑块破裂表现。IVUS表明，在急性冠状动脉综合征中存活的患者的罪犯病变往往也更软，钙化较少，并且与导致稳定冠状动脉综合征的病变相比，具有更多伴有阳性动脉重塑（代偿性扩大）的斑块。动脉重塑也是冠状动脉介入术后再狭窄的一个重要组成部分。IVUS提示，减少再狭窄的干预措施往往对预防负性重塑（狭窄）的影响更大，而不是减少内膜增生。氧化应激可能是负性重塑的一个重要促成因素，因为IVUS已在冠状动脉痉挛部位显示出这种解剖结构。IVUS所见的阳性重塑也与内皮血管运动功能障碍受损有关，并且IVUS研究已证明血管运动张力对动脉弹性的作用。未来的方向包括将IVUS与其他成像模式（如血管造影）相结合，以研究动脉粥样硬化进展过程中解剖和生理因素的相互作用，以及利用原始超声信号区分斑块成分和壁应变差异，这可能识别易损斑块。
