Amano Hideo, Koizumi Masayuki, Okubo Ryo, Yabe Takayuki, Watanabe Ippei, Saito Daiga, Toda Mikihito, Ikeda Takanori
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Department of Cardiovascular Medicine, Toho University Faculty of Medicine, Tokyo, Japan.
Am J Cardiol. 2017 May 15;119(10):1512-1517. doi: 10.1016/j.amjcard.2017.02.025. Epub 2017 Mar 1.
It has been reported that the internal running vasa vasorum (VV) was associated with plaque vulnerability, and microchannels in optical coherence tomography (OCT) are consistent pathologically with VV. We investigated plaque vulnerability and incidence of slow flow during percutaneous coronary intervention of the internal longitudinal running VV. Subjects were 71 lesions that underwent OCT before percutaneous coronary intervention. Internal running VV was defined as intraplaque neovessels running from the adventitia to plaque. Lesions with internal running VV were found in 47% (33 of 71). Compared with lesions without internal running VV, lesions with internal running VV showed significantly higher incidence of intimal laceration (64% [21 of 33] vs 16% [6 of 38], p <0.001), lipid-rich plaque (79% [26 of 33] vs 26% [10 of 38], p <0.001), plaque rupture (52% [17 of 33] vs 13% [5 of 38], p <0.001), thin-cap fibroatheroma (58% [19 of 33] vs 11% [4 of 38], p <0.001), macrophage accumulation (61% [20 of 33] vs 26% [10 of 38], p = 0.004), intraluminal thrombus (36% [12 of 33] vs 3% [1 of 38], p <0.001), and slow flow after stent implantation (42% [14 of 33] vs 13% [5 of 38], p = 0.007). The multivariable analysis showed that internal running VV was an independent predictor of slow flow after stent implantation (odds ratio 4.23, 95% confidence interval 1.05 to 17.01, p = 0.042). In conclusion, compared with those without, plaques with internal running VV in OCT had high plaque vulnerability with more intimal laceration, lipid-rich plaque, plaque rupture, thin-cap fibroatheroma, macrophage accumulation, and intraluminal thrombus, and they had high incidence of slow flow after stent implantation.
据报道，内部走行的血管滋养血管（VV）与斑块易损性相关，光学相干断层扫描（OCT）中的微通道在病理上与VV一致。我们研究了内部纵向走行的VV在经皮冠状动脉介入治疗期间的斑块易损性和慢血流发生率。研究对象为71个在经皮冠状动脉介入治疗前接受OCT检查的病变。内部走行的VV定义为从外膜延伸至斑块内的斑块内新生血管。在71个病变中，47%（33个）发现有内部走行的VV。与无内部走行VV的病变相比，有内部走行VV的病变内膜撕裂发生率显著更高（64%[33个中的21个]对16%[38个中的6个]，p<0.001）、富含脂质斑块发生率更高（79%[33个中的26个]对26%[38个中的10个]，p<0.001）、斑块破裂发生率更高（52%[33个中的17个]对13%[38个中的5个]，p<0.001）、薄帽纤维粥样斑块发生率更高（58%[33个中的19个]对11%[38个中的4个]，p<0.001）、巨噬细胞聚集发生率更高（61%[33个中的20个]对26%[38个中的10个]，p = 0.004）、腔内血栓发生率更高（36%[33个中的12个]对3%[38个中的1个]，p<0.001）以及支架植入后慢血流发生率更高（42%[33个中的14个]对13%[38个中的
