造影正常冠状动脉左主干的血管内超声研究

摘要

目的 探讨冠状动脉造影正常左主干的血管内超声特征.方法 选取冠状动脉造影显示单纯左前降支或左回旋支病变而左主干正常同时行血管内超声(IVUS)检查的76例患者.应用IVUS测量病变部位的斑块负荷,确定斑块的性质.同时确定左主干是否存在病变,若存在病变则确定病变性质;测量左主干的管腔直径和面积以及血管直径和面积;对存在动脉粥样硬化者,测量斑块负荷.结果 76例冠状动脉造影正常左主干患者中IVUS显示完全正常28例,内膜增生12例,有斑块36例,发现内膜斑片2例.对于存在斑块者偏心斑块为30例,向心斑块为6例;脂质斑块25例(占69.4%),纤维斑块4例(占11.1%),钙化斑块2例(占5.6%),混合斑块5例(占13.9%).IVUS显示女性左主干正常者的管腔直径为(5.32±0.68)mm,管腔面积为(23.34±5.27)mm2,男性左主干正常者的管腔直径为(5.90±0.50)mm,管腔面积为(27.75±4.47)mm2.男女管腔直径和管腔面积比较差别均有统计学意义(P值分别为0.042和0.048).内膜增生者血管直径为(5.90±0.47)mm,血管面积为(27.58±4.21)mm2;存在斑块者的管腔直径为(4.39±0.54)mm,管腔面积为(17.45±5.23)mm2,血管直径为(5.99±0.67)mm,血管面积为(26.61±6.27)mm2,直径狭窄百分比为(26.17±7.87)%,斑块负荷为(34.79±9.37)%.结论 IVUS能发现冠状动脉造影所无法显示的左主干病变,并且能精确地确定左主干病变的性质和严重程度.%Objective To investigate the ultrasonic characteristics of angiographical normal left main (LM) branch of coronary artery observing with intravaseular ultrasound(IVUS). Methods Seventy-six patients whose coronary angiogram showed the lesions restricted only in left anterior descending (LAD) branch or left cireumflex(LCX) branch and no lesion was found in LM branch were enrolled and IVUS was performed. The plaque burden was measured and the quality of atherosclerosis was identified in lesion site of LAD or LCX by IVUS. Meanwhile,the absence or existence of lesions in LM was identified,and the quality of lesions was analyzed if it showing those existed lesions. The diameter and area of lumen in left main were measured and diameter and area of vessel were also measured. The plaque burden were measured for those who atheroselerosis existed in LM. Results IVUS showed 28 cases completely normal, 12 cases with intimal membrance hyperplesia,36 cases with plaque and 2 cases with intimal membrance flap in patients which LM was angiographically normal. Among those there were 30 eccentric plaques and 6 concentric plaques. For 36 patients whose lesions existed in LM observed by IVUS,there were 25 cases (69.4%) with soft plaque,4 eases (11.1%) with fibrous plaque,2 cases (5.6%) with calcific plaque,5 cases (13.9%)with mixed plaque. IVUS showed lumen diameter was (5.32±0.68)mm and lumen area was (23.34±5.27)mm2 for female patients; and lumen diameter was (5.90±0.50)mm and lumen area was (27.75±4.47)mm2 for male patients. The difference had significane when comparing lumen diameter and lumen area between male and female patients (P=0.042 and P=0.048, respectively). Vessel diameter was (5.90±0.47)mm and vessel area was (27.58±4.21)mm2 in patients with intimal membrance hyperplesia; lumen diameter was (4.39±0.54)mm and lumen area was (17.45±5.23)mm2,vessel diameter was (5.99±0.67)mm and vessel area was(26.61±6.27)mm2 n patients with atherosclerotic plaque.Diameter stenosis percentage was(26.17±7.87)%and plaque burden was(34.79±9.37)%in LM.Conclusions IVUS can find those lesions in LM which CAG cannot detect and identify the quality and severity of lesion precisely.