Bartorelli A L, Leon M B, Almagor Y, Prevosti L G, Swain J A, McIntosh C L, Neville R F, House M D, Bonner R F
Cardiology Branch, National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Maryland.
J Am Coll Cardiol. 1991 May;17(6 Suppl B):160B-168B. doi: 10.1016/0735-1097(91)90953-7.
Arterial wall perforation and chronic restenosis represent important factors limiting the clinical application of laser angioplasty. Discrimination of normal and atherosclerotic vessels by laser-excited fluorescence spectroscopy may offer a means of targeting plaque ablation, thereby reducing the frequency of restenosis and transmural perforation. In this study, with use of a 325 nm low power helium-cadmium laser, in vivo endogenous surface fluorescence was excited through a flexible 200 microns optical fiber within a 0.018 in. (0.046 cm) guide wire in contact with the intima of 268 vascular interrogation sites from 48 patients either during open heart surgery or during percutaneous catheterization procedures. Fluorescence spectra could be recorded in all patients in bloodless and blood-filled arteries. Endogenous surface fluorescence was analyzed measuring peak intensity, peak position and shape index of the spectra. Compared with normal wall, noncalcified and calcified coronary atheroma showed a 42% (p less than 0.001) and a 58% (p less than 0.001) decrease of peak intensity, and higher shape index (p less than 0.001 and p less than 0.01, respectively). In addition, peak position was shifted to longer wavelengths for noncalcified coronary atheroma (p less than 0.001). Compared with normal aorta sites, aortic plaques demonstrated a 46% decrease of peak intensity, longer peak position wavelengths (p less than 0.05) and a higher shape index (p less than 0.001). Using an atheroma detection algorithm, prospective analysis of aorta and coronary spectra showed a specificity of 100% for identifying normal sites and a sensitivity of 73% for recognizing atherosclerotic sites.(ABSTRACT TRUNCATED AT 250 WORDS)
动脉壁穿孔和慢性再狭窄是限制激光血管成形术临床应用的重要因素。通过激光激发荧光光谱法区分正常血管和动脉粥样硬化血管，可能为靶向斑块消融提供一种方法，从而减少再狭窄和透壁穿孔的发生率。在本研究中，使用325nm低功率氦镉激光器，通过一根0.018英寸（0.046厘米）导丝内的200微米柔性光纤，在48例患者的268个血管检查部位的内膜上激发体内内源性表面荧光，这些检查部位是在心脏直视手术或经皮导管插入术过程中进行的。在所有患者的无血和充血动脉中均可记录荧光光谱。对内源性表面荧光进行分析，测量光谱的峰值强度、峰值位置和形状指数。与正常血管壁相比，非钙化和钙化冠状动脉粥样硬化斑块的峰值强度分别降低了42%（p<0.001）和58%（p<0.001），且形状指数更高（分别为p<0.001和p<0.01）。此外，非钙化冠状动脉粥样硬化斑块的峰值位置向更长波长偏移（p<0.001）。与正常主动脉部位相比，主动脉斑块的峰值强度降低了46%，峰值位置波长更长（p<0.05），形状指数更高（p<0.001）。使用动脉粥样硬化检测算法，对主动脉和冠状动脉光谱进行前瞻性分析，结果显示识别正常部位的特异性为100%，识别动脉粥样硬化部位的敏感性为73%。（摘要截短于250字）
