Štěchovský Cyril, Hájek Petr, Horváth Martin, Špaček Miloslav, Veselka Josef
Department of Cardiology, 2nd Medical School, Charles University, Motol University Hospital, V Uvalu 84, 150 06, Prague 5, Czech Republic.
Int J Cardiovasc Imaging. 2016 Jan;32(1):181-8. doi: 10.1007/s10554-015-0687-x. Epub 2015 Jun 5.
Limited insights into the pathophysiology of the atherosclerotic carotid stenosis are available in vivo. We conducted a prospective study to assess safety and feasibility of intravascular ultrasound (IVUS) combined with near-infrared spectroscopy (NIRS) in carotid arteries. In addition, we described the size and the distribution of lipid rich plaques in significant atherosclerotic carotid stenoses. In a prospective single centre study 45 consecutive patients (mean age 66 ± 8 years) with symptomatic (≥50 %) or asymptomatic (≥70 %) stenosis of internal carotid artery (ICA) amendable to carotid stenting were enrolled. A 40 mm long NIRS-IVUS pullback through the stenosis was performed. IVUS and NIRS data were analyzed to assess minimal luminal area (MLA), plaque burden (PB), remodeling index (RI), calcifications, lipid core burden index (LCBI), maximal LCBI in any 4 mm segment of the artery (LCBImx) and LCBI in the 4 mm segment at the site of minimal luminal area (LCBImxMLA). NIRS-IVUS pullbacks were safely performed without overt clinical events. LCBImx was significantly higher than LCBImxMLA (369.1 ± 221.1 vs. 215.7 ± 2589; p = 0.004). Conversely, PB was significantly larger at the site of MLA (87.4 ± 4.8 % vs. 58.3 ± 18.2 %; p < 0001). Distance of the NIRS-IVUS frame with the highest LCBI from the site of MLA was 6.5 ± 7.7 mm. Eighty percent of frames with maximal LCBI were localized within 10 mm from the site of MLA and 67 % proximally to or at the site of MLA. This study suggested safety and feasibility of the NIRS-IVUS imaging of the carotid stenosis and provided insights on the distribution of lipids in the carotid stenosis. Lipid rich plaques were more often located in the sites with a milder stenosis and smaller plaque burden than at the site of MLA.
目前对于动脉粥样硬化性颈动脉狭窄的病理生理学在活体中的认识有限。我们进行了一项前瞻性研究，以评估血管内超声（IVUS）联合近红外光谱（NIRS）在颈动脉中的安全性和可行性。此外，我们描述了显著动脉粥样硬化性颈动脉狭窄中富含脂质斑块的大小和分布。在一项前瞻性单中心研究中，连续纳入了45例（平均年龄66±8岁）适合颈动脉支架置入术的有症状（≥50%）或无症状（≥70%）的颈内动脉（ICA）狭窄患者。通过狭窄部位进行了一次40毫米长的NIRS-IVUS回撤操作。对IVUS和NIRS数据进行分析，以评估最小管腔面积（MLA）、斑块负荷（PB）、重塑指数（RI）、钙化、脂质核心负荷指数（LCBI）、动脉任何4毫米节段中的最大LCBI（LCBImx）以及最小管腔面积部位4毫米节段中的LCBI（LCBImxMLA）。NIRS-IVUS回撤操作安全完成，未发生明显临床事件。LCBImx显著高于LCBImxMLA（369.1±221.1对215.7±2589；p = 0.004）。相反，在MLA部位的PB显著更大（87.4±4.8%对58.3±18.2%；p < 0.001）。LCBI最高的NIRS-IVUS帧距MLA部位的距离为6.5±7.7毫米。80%的最大LCBI帧位于距MLA部位10毫米内，67%位于MLA部位近端或该部位。这项研究表明了NIRS-IVUS对颈动脉狭窄成像的安全性和可行性，并提供了关于颈动脉狭窄中脂质分布的见解。富含脂质的斑块更多位于狭窄较轻且斑块负荷较小的部位，而非MLA部位。
