Leber Alexander W, von Ziegler Franz, Becker Alexander, Becker Christoph R, Reiser Maximilian, Steinbeck Gerhard, Knez Andreas, Boekstegers Peter
Medizinische Klinik I, Klinikum Grosshadern, Department of Cardiology, Ludwig Maximilians University of Munich, Marchioninistrasse 15, 81377, Munich, Germany.
Int J Cardiovasc Imaging. 2008 Apr;24(4):423-8. doi: 10.1007/s10554-007-9278-9. Epub 2007 Nov 8.
The aim of the present study was to characterize coronary plaques by Multi-Slice Computed Tomography (Siemens sensation 16, Forcheim, Germany) before significant angiographic progression occurred and to compare them to non-progressing lesions. The MSCT-morphology of coronary plaques leading to a rapid angiographic disease progression is not yet studied. In a series of 68 patients who were scheduled for surveillance angiography 6 months later, MSCT-angiography was done shortly after the baseline catheterisation-procedure. After surveillance angiography rapid progressive lesions with an increase of the stenosis severity of >20% were identified and analysed on the baseline MSCT-scan and were compared to non-progressing lesions. Six months after coronary stenting we observed significant progression of de novo stenoses in 10/438 coronary segments. The progression of four lesions lead to angina pectoris symptoms and the remaining six lesions progressed silently. Analysis of the lesion morphology by MSCT revealed that 5/10 (50%) progressing lesions were non-calcified 3/10 (30%) were predominantly non-calcified and 2/10 (20%) were mainly calcified on the baseline MSCT-scan. In the 428 segments without disease progression atherosclerotic lesions were found in 225 segments on MSCT. Non-calcified plaques were identified in 46 (20%), predominantly non-calcified lesions in 58 (26%) and predominantly calcified lesions in 121 (54%) segments. The average number of diseased coronary segments between patients with and without lesion progression was not significantly different between progressors and non-progressors with a higher prevalence of non-calcified segments in the progressor group (1.1 vs. 0.63). Rapid progression of the angiographic stenosis severity during a 6 months period occurs most frequently in coronary segments revealing non-calcified or predominantly non-calcified plaques as determined by MSCT, whereas lesion progression is rare in predominantly calcified segments. This represents first evidence that non-calcified lesions may be involved in the process of plaque rupture.
本研究的目的是在显著的血管造影进展发生之前，通过多层螺旋计算机断层扫描（西门子Sensation 16，德国福希海姆）对冠状动脉斑块进行特征描述，并将其与无进展病变进行比较。导致血管造影疾病快速进展的冠状动脉斑块的MSCT形态尚未得到研究。在一系列68例计划在6个月后进行监测血管造影的患者中，在基线导管插入术后不久进行了MSCT血管造影。在监测血管造影后，识别出狭窄严重程度增加>20%的快速进展性病变，并在基线MSCT扫描上进行分析，并与无进展病变进行比较。冠状动脉支架置入术后6个月，我们观察到438个冠状动脉节段中有10个出现了新生狭窄的显著进展。4个病变的进展导致心绞痛症状，其余6个病变无症状进展。通过MSCT对病变形态的分析显示，在基线MSCT扫描上，10个进展性病变中有5个（50%）为非钙化，3个（30%）主要为非钙化，2个（20%）主要为钙化。在428个无疾病进展的节段中，MSCT发现225个节段有动脉粥样硬化病变。在46个节段（20%）中识别出非钙化斑块，在58个节段（26%）中识别出主要为非钙化病变，在121个节段（54%）中识别出主要为钙化病变。有病变进展和无病变进展患者之间患病冠状动脉节段的平均数量在进展者和无进展者之间没有显著差异，进展者组中非钙化节段的患病率更高（1.1对0.63）。如MSCT所确定的，在6个月期间血管造影狭窄严重程度的快速进展最常发生在显示非钙化或主要为非钙化斑块的冠状动脉节段，而在主要为钙化的节段中病变进展很少见。这首次证明非钙化病变可能参与了斑块破裂过程。
