急性心肌梗死患者的血管内超声成像：与慢性稳定型心绞痛的比较。

Intravascular ultrasound imaging in patients with acute myocardial infarction: comparison with chronic stable angina pectoris.

作者信息

Bocksch W G, Schartl M, Beckmann S H, Dreysse S, Paeprer H

机构信息

Division of Cardiology, Klinikum Rudolf Virchow, Freie Universitaet Berlin, Germany.

出版信息

Coron Artery Dis. 1994 Sep;5(9):727-35.

PMID:7858762

Abstract

BACKGROUND

Myocardial infarction is the result of acute thrombotic occlusion of a coronary artery, most likely secondary to rupture of an atherosclerotic plaque. Intracoronary ultrasonic (ICUS) examinations were performed in patients with acute myocardial infarction (AMI) in order to describe intraluminal ultrasonic findings at the site of acute coronary occlusion.

METHODS

Coronary angiography and ICUS studies were performed consecutively within 6 h of the onset of chest pain in 30 patients with AMI prior to percutaneous transluminal coronary angioplasty (PTCA). The control group consisted of 30 patients with chronic stable angina pectoris (SAP). Following angiographic documentation of a proximal stenosis or occlusion, a 3.5 or 4.8 F mechanical ultrasound catheter (20 MHz) was advanced successfully through the lesion in 25 of 30 (83%) patients with AMI and in 15 of 30 (50%) patients with SAP (P < 0.01).

RESULTS

Intracoronary ultrasound permitted differentiation between pulsatile, low-echogenic intraluminal material suggesting thrombus and mural highly echogenic atherosclerotic plaque in 22 of 25 (88%) patients with AMI. A negative imprint of the ICUS catheter was documented within the low-echogenic material in 17 of 25 (68%) patients with AMI. Low-echogenic intraluminal material was found in 18 of 25 (72%) segments proximal and in 12 of 25 (48%) segments distal to the highly echogenic plaque, indicating prestenotic and post-stenotic thrombus in AMI. The plaque appeared eccentric in 22 of 25 (88%) patients with AMI. In comparison, stenotic lesions in chronic SAP patients were less frequently eccentric (5/15, 33%, P < 0.01) and contained a higher proportion of pure highly echogenic material (12/15, 80%). Cross-sectional area stenosis due to highly echogenic plaque averaged 52 +/- 13% in AMI and 82 +/- 3% in SAP (P < 0.01). Calcification of plaque was evident in 21 of 25 patients with AMI (SAP 12/15, 80%, NS). The surface of the plaque was rough in 13 of 25 (52%) AMI patients (SAP 4/15, 27%, P < 0.05). Fissures were detected in only seven (28%) patients and dissection was observed in two (8%) cases. The low incidence might be a result of the limited resolution of the ICUS system.

CONCLUSION

This study demonstrates that ICUS with 4.8 or 3.5 F catheters is feasible and safe in selected patients with AMI, and adds little to the overall duration of the angioplasty procedure. The identification and demarcation of atherosclerotic plaque provided by ICUS could prove valuable in guiding PTCA, in deciding on appropriate therapy, and in acute and long-term follow-up of AMI patients.

摘要

背景

心肌梗死是冠状动脉急性血栓闭塞的结果，很可能继发于动脉粥样硬化斑块破裂。对急性心肌梗死（AMI）患者进行冠状动脉内超声（ICUS）检查，以描述急性冠状动脉闭塞部位的腔内超声表现。

方法

在30例AMI患者胸痛发作6小时内，于经皮腔内冠状动脉成形术（PTCA）前连续进行冠状动脉造影和ICUS研究。对照组由30例慢性稳定型心绞痛（SAP）患者组成。在血管造影记录到近端狭窄或闭塞后，30例AMI患者中的25例（83%）和30例SAP患者中的15例（50%）成功将3.5或4.8F机械超声导管（20MHz）推进穿过病变部位（P<0.01）。

结果

在25例AMI患者中的22例（88%），冠状动脉内超声能够区分提示血栓的搏动性、低回声腔内物质和壁内高回声动脉粥样硬化斑块。25例AMI患者中的17例（68%）在低回声物质内记录到ICUS导管的负性印记。在高回声斑块近端的25个节段中的18个（72%）和远端的25个节段中的12个（48%）发现低回声腔内物质，表明AMI存在狭窄前和狭窄后血栓。25例AMI患者中的22例（88%）斑块呈偏心性。相比之下，慢性SAP患者的狭窄病变较少呈偏心性（5/15，33%，P<0.01），且纯高回声物质比例更高（12/15，80%）。高回声斑块导致的横截面积狭窄在AMI患者中平均为52±13%，在SAP患者中为82±3%（P<0.01）。25例AMI患者中的21例（SAP为12/15，80%，无显著性差异）斑块有钙化。25例AMI患者中的13例（52%）斑块表面粗糙（SAP为4/15，27%，P<0.05）。仅在7例（28%）患者中检测到裂隙，2例（8%）观察到夹层。低发生率可能是ICUS系统分辨率有限的结果。