Objective To evaluate the potential value of intravascular ultrasound(IVUS)imaging in the diagnosis of aortic intramural hematoma(AIH).Methods From September 2002 to May 2005,a consecutive series of 15 patients with s...Objective To evaluate the potential value of intravascular ultrasound(IVUS)imaging in the diagnosis of aortic intramural hematoma(AIH).Methods From September 2002 to May 2005,a consecutive series of 15 patients with suspected aortic dissection(AD)underwent both IVUS imaging and spiral computed tomography(CT).Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group.Results The study group consisted of five males and one female with mean age of 66 years old.All of them had chest or back pain.In one patient,CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer(PAU),which were detected by IVUS.In another patient,CT mistaken a partly thrombosed false lumen as an AIH,whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen.In the four rest patients,both CT and IVUS made the diagnosis of AIH,however,IVUS detected three PAUs in three of them,only one of them was also detected by CT,and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging.Conclusions IVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH,particularly for diagnosing localized AIH,distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs.展开更多
BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinici...BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.展开更多
Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent...Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent fracture,stent thrombosis and even coronary perforation are still high.[1,2]Meanwhile,the necessity of revascularization in such patients is worth prudent evaluation.Cardiac imaging modalities are crucial and helpful in making revascularized decisions and strategies.Herein,we report a case using quantitative flow ratio(QFR)and intravascular ultrasound(IVUS)to facilitate accurate revascularization in a patient with both severe coronary stenosis and deep coronary MB.展开更多
Objective:To study the correlation between plasma lipopolysaccharide and coronary atherosclerotic heart disease risk factors and plaque stability.Methods:136 patients with unstable angina pectoris who underwent corona...Objective:To study the correlation between plasma lipopolysaccharide and coronary atherosclerotic heart disease risk factors and plaque stability.Methods:136 patients with unstable angina pectoris who underwent coronary angiography and intravascular ultrasound were selected from the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine.According to the results of IVUS,they were divided into stable plaques(stable plaques,SP)group of 72 patients With 64 cases in the Unstable plaques(UP)group,venous blood was drawn from the two groups of patients for blood lipid and lipopolysaccharide index detection,and the general baseline data of the two groups were recorded;the structural characteristics of the intravascular ultrasound plaques in the two groups were analyzed.To study the influencing factors of unstable plaques,the correlation between lipopolysaccharide and plaque structural characteristics,and the diagnostic efficacy of unstable plaques.Results:The expression levels of cholesterol,low-density lipoprotein,and LPS in the UP group were higher than those in the SP group(P<0.05),and the high-density lipoprotein expression levels were lower than those in the SP group(P=0.035);and the intravascular ultrasound structure of the plaque was UP The lipid pool area,the ratio of lipid pool to plaque area,the plaque eccentricity index,and the maximum plaque thickness of the group were higher than those of the SP group(P<0.05),and the minimum plaque thickness was smaller than that of the SP group and the difference was statistically significant(P<0.05);LPS was positively correlated with cholesterol,low-density lipoprotein,lipid pool area,ratio of lipid pool to plaque area,plaque eccentricity index,and maximum plaque thickness by Pearson correlation test(P<0.05),Is negatively correlated with high-density lipoprotein(P=0.021);LPS is a risk factor for coronary plaque stability,and HDL is a protective factor for coronary plaque stability by binary logistic regression test.The difference is statistically significant Scientific significance(P=0.049,P=0.002);LPS diagnosis of coronary atherosclerotic plaque stability ROC area under the curve(AUC)is 0.889,95%CI is(0.805,0.974),the best diagnosis point is 57.485 mg/L,the sensitivity is 80.60%,and the specificity is 73.70%.Conclusion:Plasma lipopolysaccharide is a risk factor of unstable plaque,which has certain diagnostic value for coronary artery plaque,and can be used as a quantitative diagnostic index of plaque vulnerability.展开更多
Intravascular ultrasound( IVUS) is an important imaging technique that is used to study vascular wall architecture for diagnosis and assessment of the vascular diseases. Segmentation of lumen and media-adventitia boun...Intravascular ultrasound( IVUS) is an important imaging technique that is used to study vascular wall architecture for diagnosis and assessment of the vascular diseases. Segmentation of lumen and media-adventitia boundaries from IVUS images is a basic and necessary step for quantitative assessment of the vascular walls.Due to ultrasound speckles, artifacts and individual differences,automated segmentation of IVUS images represents a challenging task. In this paper,a random walk based method is proposed for fully automated segmentation of IVUS images. Robust and accurate determination of the seed points for different regions is the key to successful use of the random walk algorithm in segmentation of IVUS images and is the focus of the present work. Performance of the proposed algorithm was evaluated over an image database with 900 IVUS image frames of nine patient cases. The preliminary experimental results show the potential of the proposed IVUS image segmentation approach.展开更多
Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side...Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side branch are considered to be strong predictors of reduced technical success.[ 2,3] For such lesions, the antegrade approach may not be feasible or desirable, and the retrograde approach can be used as the initial crossing strategy. However, when treating the blunt CTO with a large side branch proximal to the occlusion, the side branch might be occluded after stent implantation if the retrograde guidewire passed the occluded segment through the subintimal space and re-entered into the true lumen at the opposite side of the side branch.[4] We reported a useful method to solve the above issue which utilizes intravascular ultrasound (IVUS) to guide “extended” reverse controlled antegrade and retrograde subintimal tracking (CART) technique with a cutting balloon.展开更多
Intravascular ultrasound can provide high-resolution real-time cross-sectional images about lumen, plaque and tissue. Traditionally, the luminal border and medial-adventitial border are traced manually. This process i...Intravascular ultrasound can provide high-resolution real-time cross-sectional images about lumen, plaque and tissue. Traditionally, the luminal border and medial-adventitial border are traced manually. This process is extremely time-consuming and the subjective difference would be large. In this paper, a new automated contour detection method is introduced based on fast active contour model. Experimental results found that lumen and vessel area measurements after automated detection showed good agreement with manual tracings with high correlation coefficients (0.94 and 0.95, respectively) and small system difference (-0.32 and 0.56, respectively). So it can be a reliable and accurate diagnostic tool.展开更多
Intravascular ultrasound (IVUS) is a new technology for the diagnosis of coronary artery disease, and for the support of coronary intervention. IVUS image segmentation often encounters difficulties when plaque and aco...Intravascular ultrasound (IVUS) is a new technology for the diagnosis of coronary artery disease, and for the support of coronary intervention. IVUS image segmentation often encounters difficulties when plaque and acoustic shadow are present A novel approach for hard plaque recognition and media-adventitia border detection of IVUS images is presented in this paper. The IVUS images were first enhanced by a spatial-frequency domain filter that was constructed by the directional filter and histogram equalization. Then, the hard plaque was recognized based on the intensity variation within different regions that were obtained using the k-means algorithm. In the next step, a cost matrix representing the probability of the media-adventitia border was generated by combining image gradient, plaque location and image intensity. A heuristic graph-searching was applied to find the media-adventitia border from the cost matrix.Experiment results showed that the accuracy of hard plaque recognition and media-adventitia border detection was 89.94% and 95.57%, respectively. In conclusion,using hard plaques recognition could improve media-adventitia border detection in IVUS images.展开更多
Objective:To analyse the correlation between the characteristics of coronary plaque in coronary heart disease(CHD)patients with phlegm-blood stasis syndrome(PBS)and blood stasis syndrome(BSS).Methods:Patients were div...Objective:To analyse the correlation between the characteristics of coronary plaque in coronary heart disease(CHD)patients with phlegm-blood stasis syndrome(PBS)and blood stasis syndrome(BSS).Methods:Patients were divided into different groups based on Chinese medicine(CM)syndrome differentiation.The baseline demographics and clinical variables were collected from the medical records.Additionally,the characteristics of plaque and pathological manifestations in coronary artery were evaluated intravascular ultrasound(IVUS).Results:A total of 213 CHD patients were enrolled in two groups:184 were diagnosed with PBS and the remaining 29 were diagnosed with BSS.There were no significant differences in age,body mases index,proportions of patients with high blood pressure,diabetes mellitus,smoking,hyperlipidemia,history of coronary artery bypass graft and percutaneous coronary intervention,medications,index from cardiac ultrasound image,blood lipids and C-reactive protein between the two groups(P>0.05),except gender,weight and proportions of OVUS observed target vessels(P<0.05 or P<0.01).More adverse events such as acute myocardial infarction(P=0.003)and unstable angina(P=0.048)were observed in BSS.Additionally,dissection,thrombus and coronary artery ectasia were significantly increased in BSS(P<0.05 or P<0.01).In contrast,PBS had more patients with stable angina and chronic total occlusion with significantly higher SYNTAX(synergy between percutaneous coronary intervention with Taxus and coronary artery bypass surgery)scores(P<0.05 or P<0.01).Moreover,dense-calcium was significantly elevated in PBS(P<0.01).Conclusions:Coronary plaque characteristics were correlated with different CM syndromes.Patients with PBS were associated with a higher degree of calcified plaque and severe coronary artery stenosis,indicating poor clinical prognosis but with a low probability of acute coronary events.On contrast,the degree of calcified plaque in patients with BSS remained relatively low,and plaque was more vulnerable,resulting in the possibility of the occurrence of acute coronary events remaining high.展开更多
Objective:Stenting for coronary artery disease is generally accepted as a percutaneous coronary intervention(PCI),but there remain many challenges with this approach.Directional coronary atherectomy(DCA)can reduce pla...Objective:Stenting for coronary artery disease is generally accepted as a percutaneous coronary intervention(PCI),but there remain many challenges with this approach.Directional coronary atherectomy(DCA)can reduce plaque volume,and its use alone or in combination with drug-coated balloons can reduce stent implantation.However,clinical studies on DCA are limited,and its safety and effectiveness remain unclear.We aimed to evaluate the safety and effectiveness of the new DCA device-ATHEROCUT with intravascular ultrasound(IVUS)guidance.Methods:Between May 2015 and May 2018,45 patients with 48 lesions were treated electively with ATHEROCUT in Kusatsu Heart Center.We retrospectively analyzed in-hospital major adverse cardiac events(MACE),overall clinical follow-up MACE,complications rate,and dual antiplatelet therapy(DAPT)duration.Our definition of MACE included cardiac death,myocardial infarction,and target lesion revascularization(TLR).Our definition of complications included coronary perforation,thrombosis,and major bleeding.Results:The overall follow-up rate was 95.6%,and the average follow-up period was 453±320 days.In-hospital and overall MACE rates were 2.2%(TLR 0)and 11.1%(TLR 8.9%),respectively.There were no complications,except for one cerebral hemorrhage case(2.1%),which was considered irrelevant to the PCI procedure.The DAPT duration was 8.3±8.3 months,only 4.8±4.9 months in the subgroup that did not require another PCI.Conclusion:Using the ATHEROCUT device with IVUS guidance is safe,might be effective in selected patients and can shorten the DAPT period.展开更多
背景组织蛋白酶 S 和它的内长的禁止者 cystatin C 在动脉粥样硬化的致病被含有，特别在导致急性冠的症候群的匾 destabilization 和破裂。然而，传播组织蛋白酶 S 和 cystatin C 是否也与冠的匾形态学联合变化，是我们招募了的未知 ye...背景组织蛋白酶 S 和它的内长的禁止者 cystatin C 在动脉粥样硬化的致病被含有，特别在导致急性冠的症候群的匾 destabilization 和破裂。然而，传播组织蛋白酶 S 和 cystatin C 是否也与冠的匾形态学联合变化，是我们招募了的未知 yet.Methods 有不稳定的咽峡炎的 98 个病人( UA ， n=56 )或稳定的咽峡炎( SA ， n=42 )有部分狭窄在冠的 angiography 上在一根主要冠的动脉导致20%和70%直径减小。31 个健康题目用作控制。Intravascular 超声(IVUS ) 被用来评估匾形态学。血浆组织蛋白酶 S 和 cystatin C 在犯人损害地点作为 well.Results 被测量，匾区域((7.85 ?? 鐿鮲鳆 ????? 鶝 ??????? 錄 ?? 吗？？展开更多
Plaque rupture with subsequent thrombus formation isthe common pathophysiological substrate of acutecoronary syndrome (ACS). Moreno et al reported thatneovascularization as manifested by the localizedappearance of mic...Plaque rupture with subsequent thrombus formation isthe common pathophysiological substrate of acutecoronary syndrome (ACS). Moreno et al reported thatneovascularization as manifested by the localizedappearance of microvessels is increased in rupturedplaques in the human aorta. Microvessel density is alsoincreased in inflammatory lesions, with intraplaquehemorrhage and in thin-cap fibroatheromas. Microvesselsat the base of the plaque are independently展开更多
文摘Objective To evaluate the potential value of intravascular ultrasound(IVUS)imaging in the diagnosis of aortic intramural hematoma(AIH).Methods From September 2002 to May 2005,a consecutive series of 15 patients with suspected aortic dissection(AD)underwent both IVUS imaging and spiral computed tomography(CT).Six patients diagnosed as acute type B AIH by CT or IVUS composed the present study group.Results The study group consisted of five males and one female with mean age of 66 years old.All of them had chest or back pain.In one patient,CT omitted a localized AIH and an associated penetrating atherosclerotic ulcer(PAU),which were detected by IVUS.In another patient,CT mistaken a partly thrombosed false lumen as an AIH,whereas IVUS detected a subtle intimal tear and slow moving blood in the false lumen.In the four rest patients,both CT and IVUS made the diagnosis of AIH,however,IVUS detected three PAUs in three of them,only one of them was also detected by CT,and two of them escaped initial CT and were confirmed by follow up CT or magnetic resonance imaging.Conclusions IVUS imaging is a safe examination and has high accuracy in the diagnosis of AIH,particularly for diagnosing localized AIH,distinguishing AIH with thrombosed classic AD and detecting accompanied small PAUs.
文摘BACKGROUND Coronary artery spasm is a major cause of myocardial ischemia.Although coronary artery spasm has been known for a long time,its mechanism has not yet been identified.Many clinicians,especially young clinicians pay less attention to coronary artery spasm,which may lead to some patients not being appropriately diagnosed and treated in time.We report a patient with spontaneous multivessel coronary artery spasm for more than 30 years diagnosed with intravascular ultrasound(IVUS)imaging.CASE SUMMARY A 66-year-old Chinese male patient had chest squeezing at rest for more than 30 years.He had a history of cigarette smoking for more than 40 years and hypertension for 10 years.Before presenting at our institution,the patient had undergone coronary angiography 4 times and percutaneous transluminal coronary angioplasty procedures twice at other hospitals without a diagnosis of coronary artery spasm.However,his chest symptoms worsened.Spontaneous multivessel coronary artery spasm occurred during IVUS without provocation testing,and the IVUS image was recorded.Thus,the diagnosis of multifocal spontaneous coronary artery spasm was confirmed.The patient was placed on oral diltiazem,isosorbide mononitrate,and nicorandil to suppress coronary artery spasms.All medications were given at the maximum dosages tolerated by the patient.He was discharged after 5 d without complications.During the six-month follow-up period,the patient was symptom-free.CONCLUSION Coronary artery spasm is still prevalent in Eastern countries.It is essential for clinicians to be aware of coronary artery spasm,which may be hard to detect and can be lethal,in order to diagnose and treat patients appropriately.
基金supported by grants from National Key R&D Program of China (2016YFC1300304)
文摘Severe coronary stenosis concomitant with congenital coronary myocardial bridge(MB)is a tough scenario for cardiologist to perform revascularization,for which the complication rates including in-stent restenosis,stent fracture,stent thrombosis and even coronary perforation are still high.[1,2]Meanwhile,the necessity of revascularization in such patients is worth prudent evaluation.Cardiac imaging modalities are crucial and helpful in making revascularized decisions and strategies.Herein,we report a case using quantitative flow ratio(QFR)and intravascular ultrasound(IVUS)to facilitate accurate revascularization in a patient with both severe coronary stenosis and deep coronary MB.
基金Regional Fund Project of National Natural Science Foundation of China(No.81960861,81460712)Guangxi Scientific Key Research&Development Plan(No.Guike AB19110006)Guangxi Graduate Education InnovationProgram(No.YCXJ2021052)。
文摘Objective:To study the correlation between plasma lipopolysaccharide and coronary atherosclerotic heart disease risk factors and plaque stability.Methods:136 patients with unstable angina pectoris who underwent coronary angiography and intravascular ultrasound were selected from the First Affiliated Hospital of Guangxi University of Traditional Chinese Medicine.According to the results of IVUS,they were divided into stable plaques(stable plaques,SP)group of 72 patients With 64 cases in the Unstable plaques(UP)group,venous blood was drawn from the two groups of patients for blood lipid and lipopolysaccharide index detection,and the general baseline data of the two groups were recorded;the structural characteristics of the intravascular ultrasound plaques in the two groups were analyzed.To study the influencing factors of unstable plaques,the correlation between lipopolysaccharide and plaque structural characteristics,and the diagnostic efficacy of unstable plaques.Results:The expression levels of cholesterol,low-density lipoprotein,and LPS in the UP group were higher than those in the SP group(P<0.05),and the high-density lipoprotein expression levels were lower than those in the SP group(P=0.035);and the intravascular ultrasound structure of the plaque was UP The lipid pool area,the ratio of lipid pool to plaque area,the plaque eccentricity index,and the maximum plaque thickness of the group were higher than those of the SP group(P<0.05),and the minimum plaque thickness was smaller than that of the SP group and the difference was statistically significant(P<0.05);LPS was positively correlated with cholesterol,low-density lipoprotein,lipid pool area,ratio of lipid pool to plaque area,plaque eccentricity index,and maximum plaque thickness by Pearson correlation test(P<0.05),Is negatively correlated with high-density lipoprotein(P=0.021);LPS is a risk factor for coronary plaque stability,and HDL is a protective factor for coronary plaque stability by binary logistic regression test.The difference is statistically significant Scientific significance(P=0.049,P=0.002);LPS diagnosis of coronary atherosclerotic plaque stability ROC area under the curve(AUC)is 0.889,95%CI is(0.805,0.974),the best diagnosis point is 57.485 mg/L,the sensitivity is 80.60%,and the specificity is 73.70%.Conclusion:Plasma lipopolysaccharide is a risk factor of unstable plaque,which has certain diagnostic value for coronary artery plaque,and can be used as a quantitative diagnostic index of plaque vulnerability.
基金Innovation Program of Shanghai Municipal Education Commission,China(No.13YZ136)National Science&Technology Support Program during the 12th Five-Year Plan Period of China(No.2012BAI13B02)
文摘Intravascular ultrasound( IVUS) is an important imaging technique that is used to study vascular wall architecture for diagnosis and assessment of the vascular diseases. Segmentation of lumen and media-adventitia boundaries from IVUS images is a basic and necessary step for quantitative assessment of the vascular walls.Due to ultrasound speckles, artifacts and individual differences,automated segmentation of IVUS images represents a challenging task. In this paper,a random walk based method is proposed for fully automated segmentation of IVUS images. Robust and accurate determination of the seed points for different regions is the key to successful use of the random walk algorithm in segmentation of IVUS images and is the focus of the present work. Performance of the proposed algorithm was evaluated over an image database with 900 IVUS image frames of nine patient cases. The preliminary experimental results show the potential of the proposed IVUS image segmentation approach.
文摘Percutaneous coronary intervention (PCI) of chronic total occlusion (CTO) represents the most technically challenging procedure in contemporary interventional cardiology.[1] Blunt lesions and presence of proximal side branch are considered to be strong predictors of reduced technical success.[ 2,3] For such lesions, the antegrade approach may not be feasible or desirable, and the retrograde approach can be used as the initial crossing strategy. However, when treating the blunt CTO with a large side branch proximal to the occlusion, the side branch might be occluded after stent implantation if the retrograde guidewire passed the occluded segment through the subintimal space and re-entered into the true lumen at the opposite side of the side branch.[4] We reported a useful method to solve the above issue which utilizes intravascular ultrasound (IVUS) to guide “extended” reverse controlled antegrade and retrograde subintimal tracking (CART) technique with a cutting balloon.
文摘Intravascular ultrasound can provide high-resolution real-time cross-sectional images about lumen, plaque and tissue. Traditionally, the luminal border and medial-adventitial border are traced manually. This process is extremely time-consuming and the subjective difference would be large. In this paper, a new automated contour detection method is introduced based on fast active contour model. Experimental results found that lumen and vessel area measurements after automated detection showed good agreement with manual tracings with high correlation coefficients (0.94 and 0.95, respectively) and small system difference (-0.32 and 0.56, respectively). So it can be a reliable and accurate diagnostic tool.
文摘Intravascular ultrasound (IVUS) is a new technology for the diagnosis of coronary artery disease, and for the support of coronary intervention. IVUS image segmentation often encounters difficulties when plaque and acoustic shadow are present A novel approach for hard plaque recognition and media-adventitia border detection of IVUS images is presented in this paper. The IVUS images were first enhanced by a spatial-frequency domain filter that was constructed by the directional filter and histogram equalization. Then, the hard plaque was recognized based on the intensity variation within different regions that were obtained using the k-means algorithm. In the next step, a cost matrix representing the probability of the media-adventitia border was generated by combining image gradient, plaque location and image intensity. A heuristic graph-searching was applied to find the media-adventitia border from the cost matrix.Experiment results showed that the accuracy of hard plaque recognition and media-adventitia border detection was 89.94% and 95.57%, respectively. In conclusion,using hard plaques recognition could improve media-adventitia border detection in IVUS images.
基金Supported by the National Natural Science Foundation of China(No.81774219)Guangdong Provincial Science and Technology Plan(No.201710010107)Traditional Chinese Medicine Science and Technology Research Project of Traditional Chinese Medicine Hospital of Guangdong Province(No.YN2014LN06)。
文摘Objective:To analyse the correlation between the characteristics of coronary plaque in coronary heart disease(CHD)patients with phlegm-blood stasis syndrome(PBS)and blood stasis syndrome(BSS).Methods:Patients were divided into different groups based on Chinese medicine(CM)syndrome differentiation.The baseline demographics and clinical variables were collected from the medical records.Additionally,the characteristics of plaque and pathological manifestations in coronary artery were evaluated intravascular ultrasound(IVUS).Results:A total of 213 CHD patients were enrolled in two groups:184 were diagnosed with PBS and the remaining 29 were diagnosed with BSS.There were no significant differences in age,body mases index,proportions of patients with high blood pressure,diabetes mellitus,smoking,hyperlipidemia,history of coronary artery bypass graft and percutaneous coronary intervention,medications,index from cardiac ultrasound image,blood lipids and C-reactive protein between the two groups(P>0.05),except gender,weight and proportions of OVUS observed target vessels(P<0.05 or P<0.01).More adverse events such as acute myocardial infarction(P=0.003)and unstable angina(P=0.048)were observed in BSS.Additionally,dissection,thrombus and coronary artery ectasia were significantly increased in BSS(P<0.05 or P<0.01).In contrast,PBS had more patients with stable angina and chronic total occlusion with significantly higher SYNTAX(synergy between percutaneous coronary intervention with Taxus and coronary artery bypass surgery)scores(P<0.05 or P<0.01).Moreover,dense-calcium was significantly elevated in PBS(P<0.01).Conclusions:Coronary plaque characteristics were correlated with different CM syndromes.Patients with PBS were associated with a higher degree of calcified plaque and severe coronary artery stenosis,indicating poor clinical prognosis but with a low probability of acute coronary events.On contrast,the degree of calcified plaque in patients with BSS remained relatively low,and plaque was more vulnerable,resulting in the possibility of the occurrence of acute coronary events remaining high.
文摘Objective:Stenting for coronary artery disease is generally accepted as a percutaneous coronary intervention(PCI),but there remain many challenges with this approach.Directional coronary atherectomy(DCA)can reduce plaque volume,and its use alone or in combination with drug-coated balloons can reduce stent implantation.However,clinical studies on DCA are limited,and its safety and effectiveness remain unclear.We aimed to evaluate the safety and effectiveness of the new DCA device-ATHEROCUT with intravascular ultrasound(IVUS)guidance.Methods:Between May 2015 and May 2018,45 patients with 48 lesions were treated electively with ATHEROCUT in Kusatsu Heart Center.We retrospectively analyzed in-hospital major adverse cardiac events(MACE),overall clinical follow-up MACE,complications rate,and dual antiplatelet therapy(DAPT)duration.Our definition of MACE included cardiac death,myocardial infarction,and target lesion revascularization(TLR).Our definition of complications included coronary perforation,thrombosis,and major bleeding.Results:The overall follow-up rate was 95.6%,and the average follow-up period was 453±320 days.In-hospital and overall MACE rates were 2.2%(TLR 0)and 11.1%(TLR 8.9%),respectively.There were no complications,except for one cerebral hemorrhage case(2.1%),which was considered irrelevant to the PCI procedure.The DAPT duration was 8.3±8.3 months,only 4.8±4.9 months in the subgroup that did not require another PCI.Conclusion:Using the ATHEROCUT device with IVUS guidance is safe,might be effective in selected patients and can shorten the DAPT period.
基金the Science and Technology Bureau of Beijing (No. D0906006040191)
文摘Plaque rupture with subsequent thrombus formation isthe common pathophysiological substrate of acutecoronary syndrome (ACS). Moreno et al reported thatneovascularization as manifested by the localizedappearance of microvessels is increased in rupturedplaques in the human aorta. Microvessel density is alsoincreased in inflammatory lesions, with intraplaquehemorrhage and in thin-cap fibroatheromas. Microvesselsat the base of the plaque are independently
