Briguori C, Tobis J, Nishida T, Vaghetti M, Albiero R, Di Mario C, Colombo A
San Raffaele Hospital, Milan, Italy.
Eur Heart J. 2002 Feb;23(3):247-54. doi: 10.1053/euhj.2001.2730.
A small reference diameter may be the consequence of high plaque burden and diffuse disease. The reference vessel diameter in small coronary arteries may vary according to the method of measurement used. We endeavoured to confirm the difference between data from examinations conducted using angiography with that revealed by intravascular ultrasound.
Between March 1993 and October 1999, 344 consecutive patients with 419 lesions in small vessels (< or =2.75 mm, Small group) and 953 patients with 1161 lesions in large vessels (Large group) underwent intravascular ultrasound-guided percutaneous transluminal angioplasty in our Institution. The mean difference between the intravascular ultrasound and the angiographic reference diameter (Delta(IVUS-Angio)) was 1.3+/-0.5 mm in the Small group and 1.0+/-0.6 mm in the Large group (P<0.001). There was a stronger correlation between plaque burden and Delta(IVUS-Angio)in the Small group (r=0.80, P<0.001) than in the Large group (r=0.59, P<0.001). An Delta(IVUS-Angio)> or =0.30 mm occurred in 99.5% of cases in the Small group and in 90% in the Large group (P<0.001). An Delta(IVUS-Angio)> or =0.50 mm occurred in 96% of case in the Small group and 80% in the Large group (P<0.001). Predictors of Delta(IVUS-Angio)> or =0.50 in the Small group were: proximal or middle lesion site, vessel type (left anterior descending artery, diagonal and obtuse marginal branches) and female sex. An Delta(IVUS-Angio)> or =1.0 mm occurred in 71% of cases in the Small group and in 49% in the Large group (P<0.001). Predictors of Delta(IVUS-Angio)> or =1.0 mm in the Small group were: proximal or middle lesion site, female sex, and lesion length.
A high percentage of vessels measuring < or =2.75 mm are large vessels with a high plaque burden. This condition is particularly prevalent in females, with lesions in the proximal or middle left anterior descending artery, and in obtuse marginal and diagonal branches.
较小的参考直径可能是高斑块负荷和弥漫性疾病的结果。小冠状动脉的参考血管直径可能因所采用的测量方法而异。我们试图证实血管造影检查数据与血管内超声所显示的数据之间的差异。
1993年3月至1999年10月，在我们机构中，344例连续患者的419处小血管病变（直径≤2.75mm，小血管组）和953例患者的1161处大血管病变（大血管组）接受了血管内超声引导下的经皮腔内血管成形术。小血管组血管内超声与血管造影参考直径的平均差值（Δ（IVUS - Angio））为1.3±0.5mm，大血管组为1.0±0.6mm（P<0.001）。小血管组斑块负荷与Δ（IVUS - Angio）之间的相关性（r = 0.80，P<0.001）比大血管组（r = 0.59，P<0.001）更强。Δ（IVUS - Angio）≥0.30mm在小血管组99.5%的病例中出现，在大血管组90%的病例中出现（P<0.001）。Δ（IVUS - Angio）≥0.50mm在小血管组96%的病例中出现，在大血管组80%的病例中出现（P<0.001）。小血管组中Δ（IVUS - Angio）≥0.50的预测因素为：病变位于近端或中间部位、血管类型（左前降支、对角支和钝缘支）以及女性。Δ（IVUS - Angio）≥1.0mm在小血管组71%的病例中出现，在大血管组49%的病例中出现（P<0.001）。小血管组中Δ（IVUS - Angio）≥1.0mm的预测因素为：病变位于近端或中间部位、女性以及病变长度。
直径≤2.75mm的血管中有很大比例是具有高斑块负荷的大血管。这种情况在女性中尤为普遍，病变位于左前降支近端或中间、钝缘支和对角支。
