Katayama Takuji, Kubo Norifumi, Takagi Yosuke, Funayama Hiroshi, Ikeda Nahoko, Ishida Takeshi, Hirahara Taishi, Sugawara Yoshitaka, Yasu Takanori, Kawakami Masanobu, Saito Muneyasu
The Cardiovascular Division, First Department of Integrated Medicine, Omiya Medical Center, Jichi Medical School, Saitama, Japan.
Am J Cardiol. 2006 Feb 1;97(3):301-4. doi: 10.1016/j.amjcard.2005.08.043. Epub 2005 Nov 28.
This study investigated the mechanism of occurrence of the no-reflow phenomenon during stent implantation in patients with acute myocardial infarction (AMI) using intravascular ultrasound (IVUS) with volumetric analysis. Of 70 patients with AMI who underwent IVUS-guided stent implantation within 24 hours of symptom onset, 12 developed decreased Thrombolysis In Myocardial Infarction flow grade during stent implantation and without subsequent restoration to Thrombolysis In Myocardial Infarction flow grade before stenting. External elastic membrane cross-sectional area and maximum diameter at the culprit lesion as measured by IVUS before stent implantation were significantly larger in the no-reflow group (n = 12) than in the normal reflow group (n = 58; 20.1 +/- 6.5 vs 16.4 +/- 4.3 mm2, p = 0.015 for cross-sectional area and 5.2 +/- 0.9 vs 4.8 +/- 0.6 mm, p = 0.049 for maximum diameter). Plaque volume, volumetric plaque burden (plaque volume/external elastic membrane volume), and change in plaque volume during stent implantation (plaque volume after vs before) were significantly greater in the no-reflow group than in the normal reflow group (239 +/- 142 vs 178 +/- 72 mm3, p = 0.030; 0.76 +/- 0.07 vs 0.71 +/- 0.06, p = 0.010; and -46 +/- 63 vs -11 +/- 37 mm3, p = 0.013, respectively). In conclusion, high atherothrombotic burden and decreased plaque volume as detected by IVUS may be risk factors for development of the no-reflow phenomenon during stent implantation in patients with AMI.
本研究采用血管内超声（IVUS）及容积分析，探讨急性心肌梗死（AMI）患者支架植入过程中无复流现象的发生机制。在症状发作24小时内接受IVUS引导下支架植入的70例AMI患者中，12例在支架植入过程中出现心肌梗死溶栓血流分级降低，且未恢复至支架植入前的心肌梗死溶栓血流分级。无复流组（n = 12）支架植入前IVUS测量的罪犯病变处的外弹力膜横截面积和最大直径显著大于正常复流组（n = 58；横截面积分别为20.1±6.5 vs 16.4±4.3mm²，p = 0.015；最大直径分别为5.2±0.9 vs 4.8±0.6mm，p = 0.049）。无复流组的斑块体积、容积斑块负荷（斑块体积/外弹力膜体积）以及支架植入过程中斑块体积的变化（术后与术前斑块体积）均显著大于正常复流组（分别为239±142 vs 178±72mm³，p = 0.030；0.76±0.07 vs 0.71±0.06，p = 0.010；以及-46±63 vs -11±37mm³，p = 0.013）。总之，IVUS检测到的高动脉粥样硬化血栓负荷和斑块体积减小可能是AMI患者支架植入过程中无复流现象发生的危险因素。
