Rehwald Rafael, Petersen Johannes, Gratl Alexandra, Zoller Heinz, Mader Andreas, Loizides Alexander, Grams Astrid E, Klocker Josef, Glodny Bernhard
Department of Radiology, University Hospital for Radiology, Medical University of Innsbruck, Innsbruck, Tyrol, Austria.
Department of Surgery, University Hospital for Vascular Surgery, Medical University of Innsbruck, Innsbruck, Tyrol, Austria.
BMJ Open. 2016 Jun 2;6(6):e010704. doi: 10.1136/bmjopen-2015-010704.
Experimental coarctation of the aorta prevents the development of downstream atherosclerosis. The aim of this study was to find out whether or not atherosclerotic stenoses protect distal vascular territories from developing atherosclerosis in humans.
A total of 2125 vascular segments from angiographies of 101 patients were evaluated by calculating the maximum degree of stenosis (NASCET criteria), the degree of calcification, the degree of collaterals and the Friesinger score.
Stenosis ≥30-49% was found in 685 vascular segments (32.2%), ≥50-69% in 490 (23.1%), ≥70-89% in 373 (17.6%) and ≥90% in 265 (12.5%). If a stenosis of at least ≥70-89% was present in the common iliac, the external iliac or the common femoral artery, the degrees of stenosis distal to it were lower than those on the contralateral side (19.8±22.3% (CI 11.7 to 28.0) vs 25.2±20.7% (CI 21.2 to 29.1); Friesinger scores 1.1±1.2 (CI 0.6 to 1.5) vs 1.4±1.1 (CI 1.2 to 1.6); degrees of calcification 0.8±1.0 (CI 0.4 to 1.1) vs 1.2±1.1 (CI 1.2 to 1.6); p<0.05 each). This effect depended on the degree of proximal stenosis, but not on collaterals, and was most pronounced distal to stenoses of the common iliac, the superficial femoral and the popliteal artery. In regression models, stenoses of the pelvic arteries were shown to be an independent protective factor for the distal vascular territories.
Atherosclerotic stenoses seem to protect distal vascular territories from developing atherosclerosis. The underlying pathophysiological mechanism of this phenomenon remains to be determined. It could be based on pulse pressure reduction.
实验性主动脉缩窄可预防下游动脉粥样硬化的发展。本研究的目的是确定动脉粥样硬化性狭窄是否能保护人类远端血管区域免于发生动脉粥样硬化。
通过计算狭窄最大程度（北美症状性颈动脉内膜切除术标准）、钙化程度、侧支程度和弗里辛格评分，对101例患者血管造影中的2125个血管节段进行了评估。
685个血管节段（32.2%）狭窄≥30 - 49%，490个（23.1%）狭窄≥50 - 69%，373个（17.6%）狭窄≥70 - 89%，265个（12.5%）狭窄≥90%。如果在髂总动脉、髂外动脉或股总动脉中存在至少≥70 - 89%的狭窄，其远端的狭窄程度低于对侧（19.8±22.3%（95%置信区间11.7至28.0）对25.2±20.7%（95%置信区间21.2至29.1）；弗里辛格评分1.1±1.2（95%置信区间0.6至1.5）对1.4±1.1（95%置信区间1.2至1.6）；钙化程度0.8±1.0（95%置信区间0.4至1.1）对1.2±1.1（95%置信区间1.2至1.6）；每项p<0.05）。这种效应取决于近端狭窄程度，而不取决于侧支，并且在髂总动脉、股浅动脉和腘动脉狭窄的远端最为明显。在回归模型中，盆腔动脉狭窄被证明是远端血管区域的一个独立保护因素。
动脉粥样硬化性狭窄似乎能保护远端血管区域免于发生动脉粥样硬化。这一现象的潜在病理生理机制仍有待确定。其可能基于脉压降低。
