Barlis Peter, Serruys Patrick W, Gonzalo Nieves, van der Giessen Willem J, de Jaegere Peter J, Regar Evelyn
Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
Am J Cardiol. 2008 Aug 15;102(4):391-5. doi: 10.1016/j.amjcard.2008.03.071. Epub 2008 May 22.
Much currently known information about vulnerable plaque stems from postmortem studies that identified several characteristics making them prone to rupture, including the presence of a thin fibrous cap and a large lipid core. This study used optical coherence tomography (OCT) to assess culprit and remote coronary narrowings and investigate whether intracoronary OCT in living patients was able to visualize morphologic features associated with vulnerable plaque in postmortem studies. Twenty-three patients successfully underwent OCT before percutaneous coronary intervention. The culprit lesion and mild to moderate coronary narrowings remote from the target stenosis were investigated. Using OCT, the culprit lesion was found to be fibrous in 39.1%, fibrocalcific in 34.4%, and lipid rich in 26.1% of cases. Two patients met criteria for thin-cap fibroatheroma (TCFA; defined as the presence of a signal-rich fibrous cap covering a signal-poor lipid/necrotic core with cap thickness <0.2 mm). Most plaques at remote segments were proximal to the culprit lesion (73.9%) and predominantly fibrous and lipid rich. OCT identified 7 TCFA lesions in 6 patients with a mean cap thickness of 0.19 +/- 0.05 mm, extending for 103 degrees +/- 49 degrees of the total vessel circumference. At 24 months of clinical follow-up, the only event occurred in a patient with in-stent restenosis who underwent repeated percutaneous revascularization. There were no clinically apparent plaque rupture-related events in the 6 patients found to have remote TCFA. This study showed that OCT can be safely applied to image beyond the culprit lesion and can detect in vivo morphologic features associated with plaque vulnerability using retrospective pathologic examination. In conclusion, detection of TCFA, particularly in stable patients, is desirable and may principally allow for early intervention and prevention of adverse events.
目前许多关于易损斑块的已知信息来自尸检研究，这些研究确定了使其易于破裂的几个特征，包括薄纤维帽和大脂质核心的存在。本研究使用光学相干断层扫描（OCT）评估罪犯病变和远处冠状动脉狭窄，并调查活体患者的冠状动脉内OCT是否能够可视化尸检研究中与易损斑块相关的形态学特征。23例患者在经皮冠状动脉介入治疗前成功接受了OCT检查。对罪犯病变以及远离靶狭窄的轻至中度冠状动脉狭窄进行了研究。使用OCT发现，在39.1%的病例中，罪犯病变为纤维性，34.4%为纤维钙化性，26.1%为富含脂质。两名患者符合薄帽纤维粥样瘤（TCFA；定义为存在覆盖信号较弱的脂质/坏死核心的信号丰富的纤维帽，帽厚度<0.2mm）的标准。大多数远处节段的斑块位于罪犯病变近端（73.9%），主要为纤维性和富含脂质。OCT在6例患者中识别出7个TCFA病变，平均帽厚度为0.19±0.05mm，延伸至血管总周长的103°±49°。在24个月的临床随访中，唯一的事件发生在一名接受重复经皮血管重建术的支架内再狭窄患者中。在发现有远处TCFA的6例患者中，没有临床上明显的斑块破裂相关事件。本研究表明，OCT可以安全地应用于罪犯病变以外的成像，并且可以通过回顾性病理检查检测与斑块易损性相关的体内形态学特征。总之，检测TCFA，尤其是在稳定患者中，是可取的，并且可能主要允许早期干预和预防不良事件。
