Sano Koichi, Mintz Gary S, Carlier Stéphane G, Fujii Kenichi, Yasuda Takenori, Kimura Masashi, Costa Jose Ribamar, Costa Ricardo A, Lui Joanna, Weisz Giora, Moussa Issam, Dangas George D, Mehran Roxana, Lansky Alexandra J, Kreps Edward M, Collins Michael, Stone Gregg W, Moses Jeffrey W, Leon Martin B
Columbia University Medical Center and Cardiovascular Research Foundation, New York, New York, USA.
Am J Cardiol. 2006 May 15;97(10):1463-6. doi: 10.1016/j.amjcard.2005.11.080. Epub 2006 Mar 29.
Previous studies have reported differences in interventional complication rates that depend on saphenous vein graft (SVG) lesion location. However, little is known about morphologic differences between lesions in different SVG locations. We evaluated preintervention intravascular ultrasound (IVUS) images of 75 de novo SVG lesions (aorto-ostial, n = 15; shaft, n = 60) in 63 patients. IVUS data were measured at the minimal lumen area and at 2 proximal and 2 distal references. Positive remodeling was defined as a lesion site SVG area that was larger than the average of the 2 distal references. Shaft lesions more often contained soft plaque (60.0% vs 26.7%, p = 0.02). Minimal lumen areas were identical (4.5 +/- 2.9 vs 4.3 +/- 1.5 mm2, p = 0.3); however, plaque burden at the minimal lumen area was greater in shaft locations (79.3 +/- 9.4% vs 72.1 +/- 9.2%, p = 0.01). The frequency of positive remodeling in shaft versus aorto-ostial lesions was 70.2% versus 26.7% (p = 0.002). SVG shaft lesions have more soft plaque and larger plaque burdens and undergo positive remodeling more frequently than SVG aorto-ostial lesions. These IVUS differences may account for some of the location-specific differences in interventional complications.
以往研究报告称，介入并发症发生率存在差异，这取决于大隐静脉桥血管（SVG）病变的位置。然而，对于不同SVG位置病变之间的形态学差异知之甚少。我们评估了63例患者中75处初发SVG病变（主动脉开口处，n = 15；血管中段，n = 60）的介入前血管内超声（IVUS）图像。在最小管腔面积以及近端和远端的2个参考位置测量IVUS数据。正向重构定义为病变部位的SVG面积大于2个远端参考位置的平均值。血管中段病变更常含有软斑块（60.0%对26.7%，p = 0.02）。最小管腔面积相同（4.5±2.9对4.3±1.5 mm²，p = 0.3）；然而，血管中段位置最小管腔面积处的斑块负荷更大（79.3±9.4%对72.1±9.2%，p = 0.01）。血管中段病变与主动脉开口处病变的正向重构频率分别为70.2%和26.7%（p = 0.002）。与SVG主动脉开口处病变相比，SVG血管中段病变有更多的软斑块和更大的斑块负荷，并且更频繁地发生正向重构。这些IVUS差异可能是介入并发症中一些位置特异性差异的原因。
