Department of Cardiology, Changzhou TCM Hospital, Changzhou, Jiangsu Province, China.
Eur Rev Med Pharmacol Sci. 2018 Feb;22(4):1094-1101. doi: 10.26355/eurrev_201802_14396.
To evaluate the plaque distribution and composition pattern in the left main coronary artery (LMCA) disease using intracoronary ultrasound.
Intravascular ultrasound data of 50 patients from the January 2010 to December 2015 with significant LMCA bifurcation lesions, with angiographic diameter stenosis >50%, and requiring revascularization, were evaluated. Plaque burden and percentage of necrotic core (% NC) at the minimal lumen area site and maximal % NC site were measured in different segments. The segments that were included in the study are as follows: segment 1: proximal LMCA, segment 2: left anterior descending (LAD) ostium, segment 3: left circumflex branch (LCX) ostium, segment 4: proximal LAD, segment 5: proximal LCX. According to its relationship with the bifurcation ridge, the blood vessel wall was divided into the contralateral bifurcation ridge blood vessel wall and bifurcation ridge blood vessel wall.
Plaque burden results showed that the plaque eccentricity index of segment 2 and segment 3 was significantly higher than that of the other segments at sites of the minimal lumen area and maximal % NC with a statistically significant difference (p<0.05). Plaque eccentricity index of contralateral bifurcation ridge was significantly higher than that of the bifurcation ridge, and the difference was statistically significant (p<0.05). Analysis of plaque composition showed the fibrous tissue percentage of segment 2 and segment 3 was significantly higher than the other segments that at the sites of minimal lumen area and the maximal % NC site. The fibrous percentage of the contralateral bifurcation ridge was significantly lower than that of the bifurcation ridge.
Intravascular ultrasound is an effective way for detecting the distribution and composition of the atherosclerotic plaque at the left main coronary artery bifurcation and is of great significance to adjuvant interventional therapy.
应用血管内超声评价左主干冠状动脉（LMCA）病变中的斑块分布和组成模式。
对 2010 年 1 月至 2015 年 12 月期间 50 例存在严重 LMCA 分叉病变、伴血管造影狭窄程度＞50%且需要血运重建的患者的血管内超声数据进行评估。在最小管腔面积部位和最大坏死核心（NC）%部位测量不同节段的斑块负荷和坏死核心百分比（%NC）。纳入研究的节段如下：节段 1：LMCA 近段，节段 2：左前降支（LAD）开口，节段 3：回旋支（LCX）开口，节段 4：LAD 近段，节段 5：LCX 近段。根据其与分叉嵴的关系，将血管壁分为对侧分叉嵴血管壁和分叉嵴血管壁。
斑块偏心指数结果显示，最小管腔面积和最大 NC%部位的节段 2 和节段 3 的斑块偏心指数显著高于其他节段，差异具有统计学意义（p<0.05）。对侧分叉嵴的斑块偏心指数明显高于分叉嵴，差异具有统计学意义（p<0.05）。斑块成分分析显示，最小管腔面积和最大 NC%部位节段 2 和节段 3 的纤维组织百分比明显高于其他节段。对侧分叉嵴的纤维百分比明显低于分叉嵴。
血管内超声是检测左主干冠状动脉分叉处粥样硬化斑块分布和组成的有效方法，对辅助介入治疗具有重要意义。
