Bell Land General Hospital, Sakai, Japan.
Circ Cardiovasc Interv. 2010 Feb 1;3(1):63-70. doi: 10.1161/CIRCINTERVENTIONS.109.900779.
Plaque rupture may be present in the peripheral arteries of the patients at high risk for cardiovascular events and is possibly associated with vascular vulnerability.
One hundred one iliofemoral arteries from 101 patients undergoing angioplasty were studied. Intravascular ultrasound imaging was performed before intervention. Plaque rupture was defined as presence of a cavity that communicated with the lumen with an overlying residual fibrous cap fragment. Incidence, numbers, and location of the plaque rupture were investigated. Plaque rupture was found in 42 of 101 arteries (42%). Patients with plaque rupture had significantly higher prevalence of acute coronary syndrome than did patients without plaque rupture (42% vs 16%, P=0.01). By multivariable logistic regression analysis, acute coronary syndrome (P=0.004) and male sex (P=0.01) were independent clinical correlates of plaque rupture. During follow-up (median, 14.7 months), the incidence of major adverse cardiac or cerebrovascular events (death, myocardial infarction, and ischemic stroke) was similar between the 2 groups. The incidence of major adverse cardiac or cerebrovascular events plus peripheral vascular events (unplanned vascular intervention and amputation) was significantly higher in patients with plaque rupture than in patients without plaque rupture (46% vs 21%, P=0.008). By multivariable Cox regression analysis, plaque rupture (hazard ratio=2.80, 95% CI: 1.23 to 6.37, P=0.01) and Fontaine stage IV (hazard ratio=3.50, 95% CI: 1.58 to 7.71, P=0.002) were independent predictors of major adverse cardiac or cerebrovascular events plus peripheral vascular events.
Ruptured plaque of the iliofemoral arteries is a common finding. Patients with plaque rupture had a higher prevalence of history of acute coronary syndrome and lower major adverse cardiac or cerebrovascular events plus peripheral vascular event-free survival.
心血管事件高危患者的外周动脉可能存在斑块破裂，且可能与血管脆弱有关。
对 101 例行血管成形术的患者的 101 条髂股动脉进行了研究。在介入前进行了血管内超声成像。斑块破裂定义为存在与管腔相通的腔隙，伴有覆盖的残余纤维帽碎片。研究了斑块破裂的发生率、数量和位置。在 101 条动脉中有 42 条（42%）发现了斑块破裂。与无斑块破裂的患者相比，有斑块破裂的患者急性冠状动脉综合征的发生率明显更高（42% vs. 16%，P=0.01）。通过多变量逻辑回归分析，急性冠状动脉综合征（P=0.004）和男性（P=0.01）是斑块破裂的独立临床相关因素。在随访期间（中位数为 14.7 个月），两组之间主要不良心脏或脑血管事件（死亡、心肌梗死和缺血性卒中）的发生率相似。有斑块破裂的患者主要不良心脏或脑血管事件加外周血管事件（计划外血管介入和截肢）的发生率明显高于无斑块破裂的患者（46% vs. 21%，P=0.008）。通过多变量 Cox 回归分析，斑块破裂（危险比=2.80，95%CI：1.23 至 6.37，P=0.01）和 Fontaine Ⅳ期（危险比=3.50，95%CI：1.58 至 7.71，P=0.002）是主要不良心脏或脑血管事件加外周血管事件的独立预测因素。
髂股动脉的破裂斑块是一种常见的发现。有斑块破裂的患者既往急性冠状动脉综合征的发生率更高，主要不良心脏或脑血管事件加外周血管事件无复发率更低。
