Carlier Stéphane, Kakadiaris Ioannis A, Dib Nabil, Vavuranakis Manolis, O'Malley Sean M, Gul Khawar, Hartley Craig J, Metcalfe Ralph, Mehran Roxana, Stefanadis Christodoulos, Falk Erling, Stone Gregg, Leon Martin, Naghavi Morteza
Association for Eradication of Heart Attack-AEHA, 2472 Bolsover #439, Houston, TX 77005, USA.
Curr Atheroscler Rep. 2005 Mar;7(2):164-9. doi: 10.1007/s11883-005-0040-2.
Complications of vulnerable atherosclerotic plaques (rupture, luminal and mural thrombosis, intraplaque hemorrhage, rapid progression to stenosis, spasm, and so forth) lead to heart attacks and strokes. It remains difficult to identify what plaques are vulnerable to these complications. Despite recent developments such as thermography, spectroscopy, and magnetic resonance imaging, none of them is approved for clinical use. Intravascular ultrasound (IVUS), a relatively old yet widely available clinical tool for guiding intracoronary procedures, is increasingly used for characterization of atherosclerotic plaques. However, inability of IVUS in measuring plaque activity limits its value in detection of vulnerable plaques. In this review, we present new information suggesting that microbubble contrast-enhanced IVUS can measure activity and inflammation within atherosclerotic plaques by imaging vasa vasorum density. An increasing body of evidence indicates that vasa vasorum density may be a strong marker for plaque vulnerability. We suggest that a combination of structural assessment (cap thickness, lipid core, calcification, etc) and vasa vasorum density imaging by IVUS can serve as the most powerful clinically available tool for characterization of vulnerable plaques. Due to space limitations, all IVUS images and movies are posted on the website of the Ultimate IVUS Collaborative Project: http://www.ultimateivus.com.
易损动脉粥样硬化斑块的并发症（破裂、管腔和壁内血栓形成、斑块内出血、迅速进展为狭窄、痉挛等）会导致心脏病发作和中风。目前仍难以确定哪些斑块易引发这些并发症。尽管近期有热成像、光谱学和磁共振成像等技术发展，但均未获批用于临床。血管内超声（IVUS）是一种相对古老但广泛应用于指导冠状动脉介入手术的临床工具，目前越来越多地用于动脉粥样硬化斑块的特征描述。然而，IVUS无法测量斑块活性限制了其在检测易损斑块方面的价值。在本综述中，我们展示了新的信息，表明微泡对比增强IVUS可通过对滋养血管密度成像来测量动脉粥样硬化斑块内的活性和炎症。越来越多的证据表明，滋养血管密度可能是斑块易损性的一个重要标志物。我们认为，IVUS结合结构评估（帽厚度、脂质核心、钙化等）和滋养血管密度成像，可成为临床上用于描述易损斑块的最强大工具。由于篇幅限制，所有IVUS图像和视频均发布在“终极IVUS合作项目”网站：http://www.ultimateivus.com 。
