Guagliumi Giulio, Musumeci Giuseppe, Pierli Carlo, Fineschi Massimo, Musuraca Anna Chiara
Dipartimento Cardiovascolare, Ospedali Riuniti di Bergamo, Bergamo.
G Ital Cardiol (Rome). 2010 Dec;11(12 Suppl 3):16S-21S.
Atherosclerosis is a dynamic degenerative disease, which can suddenly switch from a chronic condition to clinical instability, following a process of plaque rupture and thrombotic formation. Lesions at instability risk are described as "vulnerable plaque", i.e., lesions with a future high probability of becoming an acute event. Present diagnostic and screening methods are inadequate to identify these lesions. Recent ongoing research addresses two modalities: the development of non-invasive imaging techniques for a rapid diagnostic screening of middle-low risk coronary disease, and the implementation of invasive imaging microscopic techniques--involving the coronary wall--which are associated with coronarography. Some techniques (intravascular ultrasound-optical coherence tomography)--recently introduced in the clinical setting--allow in vivo monitoring of the sequence of changes in the plaque. For the first time we have now the possibility of measuring the thickness of the fibrous cap, the presence of neo-vessels and probably the density of macrophages, identifying high-risk plaques. The imaging techniques allow to track the evolution of the atherosclerotic disease (plaque volume, thickness of cap, number of thin cap plaques) assessing its progression and regression and the efficacy of treatments.
动脉粥样硬化是一种动态退行性疾病，在斑块破裂和血栓形成过程后，它可能突然从慢性状态转变为临床不稳定状态。具有不稳定风险的病变被描述为“易损斑块”，即未来极有可能引发急性事件的病变。目前的诊断和筛查方法不足以识别这些病变。近期正在进行的研究涉及两种模式：开发用于快速诊断筛查中低风险冠心病的非侵入性成像技术，以及实施涉及冠状动脉壁的侵入性成像显微技术（与冠状动脉造影相关）。一些技术（血管内超声 - 光学相干断层扫描）最近已引入临床环境，可对斑块变化序列进行体内监测。现在我们首次有可能测量纤维帽的厚度、新生血管的存在情况以及可能的巨噬细胞密度，从而识别高风险斑块。这些成像技术能够追踪动脉粥样硬化疾病的演变（斑块体积、帽厚度、薄帽斑块数量），评估其进展和消退情况以及治疗效果。
